Volume-controlled intermittent mandatory ventilation in preterm infants with hypoxemic episodes.
OBJECTIVE
To test the hypothesis in ventilated very low birth weight infants with frequent hypoxemic episodes that volume-controlled synchronized intermittent mandatory ventilation (SIMV) vs. pressure-controlled SIMV reduces by at least 20% the time with hypoxemia (defined as SpO(2)<80%).


METHODS
Randomized cross-over design.


METHODS
University-based tertiary neonatal intensive care unit.


METHODS
15 mechanically ventilated very low birth weight infants with frequent hypoxemic episodes.


METHODS
The infants were exposed in random order to volume-controlled and pressure-controlled SIMV for 4 h each. The target tidal volume during volume-controlled SIMV was matched to the tidal volume measured during pressure-controlled SIMV. FIO(2) was adjusted using uniform criteria to maintain SpO(2) within the target range (SpO(2) 80-92%).


RESULTS
Primary outcome measure was the time with an SpO(2)<80%. Although tidal volume was maintained better during desaturations with volume-controlled SIMV, there was neither a significant difference in time with an SpO(2)<80% (expressed as proportion of total experimental time; median, interquartile range)-volume-control 10.6% (9.2-13.7%) vs. pressure-control 10.8% (8.3-13.3%)-nor in FIO(2) exposure. During volume-controlled SIMV the infants spent less time with an SpO(2) above the target range and had fewer associated bradycardias.


CONCLUSIONS
Volume-controlled SIMV did not decrease the time with an SpO(2)<80%, although tidal volume was better maintained during these episodes and bradycardias were less frequent than with pressure-controlled SIMV in this population of very low birth weight infants with frequent hypoxemic episodes.
Hummler
Helmut D
HD
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, 89070, Ulm, Germany. helmut.hummler@uni-ulm.de
Engelmann
Anja
A
Pohlandt
Frank
F
Franz
Axel R
AR
D018592:Cross-Over Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D017063:Outcome Assessment, Health Care; D047928:Premature Birth; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*