Volume Guarantee Ventilation
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.
References (28)
- et al.
Characteristics of hypoxemic episodes in very low birth weight infants on ventilatory support
J Pediatr
(1997) - et al.
Manual ventilation with a few large breaths at birth compromises the therapeutic effect of subsequent surfactant replacement in immature lambs
Pediatr Res
(1997) - et al.
Randomised study comparing extent of hypocarbia in preterm infants during conventional and patient triggered ventilation
Arch Dis Child Fetal Neonatal Ed
(2001) - et al.
Ventilator-induced lung injury: lessons from experimental studies
Am J Respir Crit Care Med
(1998) - et al.
Lung protective strategies of ventilation in the neonate: what are they?
Pediatrics
(2000) Ventilator-induced lung injury: from barotrauma to biotrauma
Respir Care
(2005)- et al.
Mechanical ventilation in preterm infants. Neurosonographic and developmental studies
Pediatrics
(1992) - et al.
Effects of hypocarbia on the development of cystic periventricular leukomalacia in premature infants treated with high-frequency jet ventilation
Pediatrics
(1996) - et al.
Airway leak size in neonates and autocycling of three flow-triggered ventilators
Crit Care Med
(1995) - et al.
Patient-ventilator interactions in new modes of patient-triggered ventilation
Pediatr Pulmonol
(2001)
Volume guarantee accelerates recovery from forced exhalation episodes
Pediatr Res
Volume guarantee accelerates recovery from endotracheal tube suctioning in ventilated preterm infants
E-PAS
Volume guarantee ventilation, interrupted expiration and expiratory braking
Arch Dis Child
Feasibility of tidal volume-guided ventilation in newborn infants: a randomized, crossover trial using the volume guarantee modality
Pediatrics
Cited by (43)
Physiologic principles
2022, Goldsmith's Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care, Seventh EditionVolume-Targeted Ventilation
2021, Clinics in PerinatologyCitation Excerpt :If it is too low, the set Pmax level may prevent the target VTe being delivered. It has been suggested that Pmax should be set 5 to 10 cmH2O above the “working PIP” based on expert advice rather than evidence.22,45 The difficulty is that due to the large variability of PIP during VTV, it is hard to define a working PIP (see Fig. 2C, D).
“Current concepts of mechanical ventilation in neonates” – Part 1: Basics
2020, International Journal of Pediatrics and Adolescent MedicineLung-protective ventilatory strategies in intubated preterm neonates with RDS
2017, Paediatric Respiratory ReviewsCitation Excerpt :The aim of VTV was to establish a stable TV, and thus aims to reduce lung overdistension, hypocapnia, and lung injury. One mode of VTV is Volume Guarantee (VG) in which the microprocessor compares exhaled TV of the previous breath to the desired target TV, set by the operator, and adjusts the inspiratory pressure up or down to achieve that TV [35]. The most appropriate TV level for preterm with RDS has not been determined.
Pathophysiology of Ventilator-Dependent Infants
2017, Fetal and Neonatal Physiology, 2-Volume SetPhysiologic Principles
2017, Assisted Ventilation of the Neonate: An Evidence-Based Approach to Newborn Respiratory Care: Sixth Edition