title: Volume-targeted versus pressure-limited ventilation for preterm infants: a systematic review and meta-analysis.
abstract: BACKGROUND
  The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume.
  
  
  OBJECTIVE
  To determine whether volume-targeted neonatal ventilation, compared with PLV, reduces death or BPD.
  
  
  METHODS
  We performed a systematic review and meta-analysis using the methodology of the Neonatal Review Group of the Cochrane Collaboration. A comprehensive literature search was undertaken, and data for prespecified outcomes were combined where appropriate using the fixed effects model.
  
  
  RESULTS
  Nine trials were eligible. Volume-targeted ventilation resulted in a reduction in: the combined outcome of death or BPD [typical relative risk, RR, 0.73 (95% confidence interval, 0.57-0.93), numbers needed to treat, NNT, 8 (95% CI 5-33)], the incidence of pneumothorax [typical RR 0.46 (95% CI 0.25-0.84), NNT 17 (95% CI 10-100)], days of ventilation [weighted mean difference 0.8 days (log-transformed data, p = 0.05)], hypocarbia (pCO(2) <35 mm Hg/4.7 kPa); [typical RR 0.56 (95% CI 0.33-0.96), NNT 4 (95% CI 2-25)], and the combined outcome of periventricular leukomalacia or grade 3-4 intraventricular hemorrhage [typical RR 0.48 (95% CI 0.28-0.84), NNT 11 (95% CI 7-50)].
  
  
  CONCLUSIONS
  Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
authors.affiliation: Newborn Services, Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia. kevin.wheeler@thewomens.org.au
authors.forename: Kevin I
authors.initials: KI
authors.lastname: Wheeler
authors.forename: Claus
authors.initials: C
authors.lastname: Klingenberg
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Morley
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D008170:Lung Compliance; D011030:Pneumothorax / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011175:Positive-Pressure Respiration / Q000009:adverse effects / Q000379:methods*; D012123:Pulmonary Ventilation / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D013990:Tidal Volume / Q000502:physiology*