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Observational Study
. 2018 Mar;103(2):F120-F125.
doi: 10.1136/archdischild-2017-312640. Epub 2017 Jun 28.

Volume guaranteed? Accuracy of a volume-targeted ventilation mode in infants

Olivia Farrell  1   2 , Elizabeth J Perkins  1 , Don Black  1 , Martijn Miedema  1   3 , Joel Don Paul  1   2 , Prue M Pereira-Fantini  1   2 , David Gerald Tingay  1   2   4
Affiliations
Observational Study

Volume guaranteed? Accuracy of a volume-targeted ventilation mode in infants

Olivia Farrell et al. Arch Dis Child Fetal Neonatal Ed. 2018 Mar.

Abstract

Objectives: Volume-targeted ventilation (VTV) is widely used and may reduce lung injury, but this assumes the clinically set tidal volume (VTset) is accurately delivered. This prospective observational study aimed to determine the relationship between VTset, expiratory VT (VTe) and endotracheal tube leak in a modern neonatal -volume-targeted ventilator (VTV) and the resultant partial arterial pressure of carbon dioxide (PaCO2) relationship with and without VTV.

Design: Continuous inflations were recorded for 24 hours in 100 infants, mean (SD) 34 (4) weeks gestation and 2483 (985) g birth weight, receiving synchronised mechanical ventilation (SLE5000, SLE, UK) with or without VTV and either the manufacturer's V4 (n=50) or newer V5 (n=50) VTV algorithm. The VTset, VTe and leak were determined for each inflation (maximum 90 000/infant). If PaCO2 was sampled (maximum of 2 per infant), this was compared with the average VTe data from the preceding 15 min.

Results: A total of 7 497 137 inflations were analysed. With VTV enabled (77 infants), the VTset-VTe bias (95% CI) was 0.03 (-0.12 to 0.19) mL/kg, with a median of 80% of VTe being ±1.0 mL/kg of VTset. Endotracheal tube leak up to 30% influenced VTset-VTe bias with the V4 (r2=-0.64, p<0.0001; linear regression) but not V5 algorithm (r2=0.04, p=0.21). There was an inverse linear relationship between VTe and PaCO2 without VTV (r2=0.26, p=0.004), but not with VTV (r2=0.04, p=0.10), and less PaCO2 within 40-60 mm Hg, 53% versus 72%, relative risk (95% CI) 1.7 (1.0 to 2.9).

Conclusion: VTV was accurate and reliable even with moderate leak and PaCO2 more stable. VTV algorithm differences may exist in other devices.

Keywords: infant; lung injury; mechanical ventilation; tidal volume; volume targeted ventilation.

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Conflict of interest statement

Competing interests: DGT has presented at conferences and workshops in which SLE, UK, has paid unrestricted travel costs or sponsorship for the meeting. DGT has also presented at conferences and workshops supported (including speaker travel costs) by other ventilator manufacturers, including Carefusion, Dräger, Fisher Paykel and Acutronic. No author received an honorarium, grant or other forms of payment to produce the manuscript. The study was not commissioned and no commercial agencies were involved in any aspect of this study. The authors have no other competing interests to declare.

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