Elsevier

Clinics in Perinatology

Volume 34, Issue 1, March 2007, Pages 107-116.e4
Clinics in Perinatology

Volume Guarantee Ventilation

https://doi.org/10.1016/j.clp.2006.12.011Get rights and content

Recognition that volume, not pressure, is the key factor in ventilator-induced lung injury and the association of hypocarbia with neonatal brain injury demonstrate the importance of better control delivered tidal volume. New microprocessor-based ventilator modalities combine advantages of pressure-limited ventilation with the ability to deliver a more consistent tidal volume. This article discusses automatic weaning of peak inspiratory pressure in response to changing lung compliance and respiratory effort. More consistent tidal volume, fewer excessively large breaths, lower peak pressure, less hypocapnia, shorter duration of mechanical ventilation, and lower levels of inflammatory cytokines have been documented in short-term clinical trials. It remains to be seen if these short-term benefits ultimately lead to a reduced incidence of chronic lung disease.

Section snippets

Rationale for volume-targeted ventilation

Time-cycled, pressure-limited, continuous flow ventilation became the standard neonatal ventilatory mode in the 1970s and 1980s. Early attempts to use traditional volume-controlled ventilation proved to be impractical in small preterm infants, as a result of loss of tidal volume to compression of gas in the circuit and the leak around uncuffed endotracheal tubes. Pressure-limited ventilation has remained the standard method of newborn mechanical ventilation for more than 30 years, because of

Functional description of Volume Guarantee ventilation

The Volume Guarantee (VG) option available on the Draeger Babylog 8000-plus (Draeger Medical, Luebeck, Germany) may be combined with any of the standard ventilator modes (Assist/Control [A/C], Synchronized Intermittent Mandatory Ventilation [SIMV], and Pressure Support Ventilation [PSV]). The VG mode is a pressure-limited, volume-targeted, time- or flow-cycled form of ventilation. The operator chooses a target tidal volume and selects a pressure limit up to which the inspiratory pressure (the

Clinical studies of VG ventilation

All studies of volume-targeted ventilation to date have focused on feasibility and short-term outcomes, rather than major long-term benefits. In a 4-hour crossover trial, Cheema and Ahluwalia [14] compared A/C with and without VG in a group of infants with acute respiratory distress syndrome (RDS), and separately evaluated SIMV with and without VG during the weaning phase in 40 premature newborn infants. During both VG periods, the infants achieved equivalent gas exchange using slightly lower

Summary

VG is one of several forms of volume-targeted ventilation shown to be feasible and safe even in ELBW infants, who now represent the majority of ventilated infants in our neonatal intensive care units and who are at greatest risk of developing chronic lung disease. VG ventilation has been demonstrated to function as intended and to lead to shorter duration of mechanical ventilation and more stable tidal volume delivery with a lower incidence of hypocarbia and excessively large tidal volumes.

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