title: Volume-targeted ventilation in infants born at or near term.
abstract: OBJECTIVE
  To determine the impact of different volume-targeted (VT) levels during volume-targeted ventilation (VTV) on the work of breathing (WOB) of infants born at or near term and to investigate whether a level of VT reduced the WOB below that experienced on respiratory support without VT.
  
  
  METHODS
  Prospective crossover study.
  
  
  METHODS
  Sixteen infants, median gestational age of 38 (range 34-41) weeks, birth weight of 3.1 (range 1.5-4.1) kg and postnatal age of 5 (range 2-17) days were studied. The infants were receiving time-cycled, pressure-limited ventilation in a continuous mandatory or in a triggered mode.
  
  
  METHODS
  The infants were studied first without VT (baseline) and then at VT levels of 4, 5 and 6 ml/kg delivered in a random order. After each VT level, the infants were returned to baseline.
  
  
  METHODS
  The WOB was assessed by measuring the transdiaphragmatic pressure-time product (PTPdi).
  
  
  RESULTS
  One infant became apnoeic at VT of 6 ml/kg. At a VT level of 4 ml/kg, four infants were making such vigorous respiratory efforts that no inflations were delivered. The median PTPdi was higher at a VT level of 4 ml/kg than at 5 ml/kg (p<0.01) or 6 ml/kg (p<0.001). Only at a VT level of 6 ml/kg was the median PTPdi lower than that at baseline (p<0.01).
  
  
  CONCLUSIONS
  Low VT levels (4 ml/kg) during VTV increase the WOB in ventilated infants born at term or near term. The results suggest that a VT level of 6 ml/kg could be used to reduce the WOB.
authors.affiliation: Division of Asthma, Allergy & Lung Biology, MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, UK.
authors.forename: Olie
authors.initials: O
authors.lastname: Chowdhury
authors.forename: Gerrard F
authors.initials: GF
authors.lastname: Rafferty
authors.forename: Silke
authors.initials: S
authors.lastname: Lee
authors.forename: Simon
authors.initials: S
authors.lastname: Hannam
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Milner
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
mesh_terms: D001724:Birth Weight; D018592:Cross-Over Studies; D005865:Gestational Age; D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D011897:Random Allocation; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume / Q000502:physiology; D016896:Treatment Outcome; D014939:Work of Breathing / Q000502:physiology