Tidal volume delivery and peak inspiratory pressure in babies
receiving volume targeted or time cycled, pressure limited ventilation: A
randomized controlled trial
Affiliations: Department of Paediatrics-Neonatology, The James Cook
University Hospital, University of Durham, Middlesbrough, UK | Department of Pediatrics-Division of
Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of
Michigan Health System, Ann Arbor, Michigan, USA
Note: [] Corresponding author: Dr. Ravi Swamy, Department of
Paediatrics-Neonatology, The James Cook University Hospital, Middlesbrough, UK.
Tel.: +44 1642 854 874; Fax: +44 1642 854 874; E-mail: ravi.swamy@ncl.ac.uk
Abstract: Objective: To study the consistency of tidal volume delivery and the
respiratory parameters in babies randomized to either volume-controlled
ventilation (VCV) or time-cycled, pressure-limited ventilation (TCPLV). Methods: 90 babies between 24 to 32 weeks' gestation who
formed part of the original controlled trial comparing VCV vs TCPLV were
studied. As a part of the study protocol, these babies were continuously
monitored for key respiratory parameters. Hourly recording of these parameters
was obtained for 78 hours or until extubation if it occurred earlier.
Consistency of tidal volume delivery and other parameters such as PIP, PEEP,
Paw, Cdyn, Ve & FiO_{2} were compared using the Student's t-test with
a two-tailed significance level of ⩽0.05. Results: Complete datasets were available on 86 babies, 45 on
VCV and 41 on TCPLV. The mean expired tidal volume was slightly higher, and the
mean FiO_{2} was lower in the VCV group compared to TCPLV. This was also
associated with a higher PIP in VCV compared to TCPLV (16.9 cmH_{2}O vs. 15.3
cmH_{2}O, p = 0.033). However, VCV was associated with significantly higher
variability of peak inspiratory pressure and significantly less variability of
tidal volume delivery (0.87 mL/kg vs 1.12 mL/kg, p = 0.009). Conclusions: Despite targeting identical exhaled tidal
volumes, VCV was associated with consistent tidal volume delivery compared to
TCPLV. This may have significance to clinical practice and future research.
