title: Volume Guarantee Ventilation: Effect on Preterm Infants with Frequent Hypoxemia Episodes.
abstract: Preterm infants on mechanical ventilation have spontaneous hypoxemia episodes (HE) triggered by decreases in lung volume and tidal volume (VT). Volume guarantee (VG) is a mode where the ventilator peak pressure is adjusted to keep the exhaled VT at a target level. The effect of VG on HE under routine clinical conditions has not been fully evaluated.
  
  
  
  To evaluate the effect of VG on HE in preterm infants in comparison to pressure control (PC) ventilation under routine clinical conditions.
  
  
  
  Twenty-four mechanically ventilated preterm infants with ≥4 HE of arterial oxygen saturation (SpO2) <75% over 8 h were enrolled. They were studied over 2 consecutive 24-hour periods of VG and PC, in random order.
  
  
  
  While the frequency of HE (SpO2 <85% for ≥20 s) did not differ, their duration was reduced during VG. The frequency or duration of severe HE (SpO2 <75% for ≥20 s) did not differ between PC and VG. The proportion of time in severe hypoxemia (SpO2 <75%) during VG did not differ from PC [median: 4.4 (IQR 2.9-5.0) vs. 5.0% (IQR 3.9-6.9), p = 0.44]. The fraction of inspired oxygen (FiO2) was lower during VG compared to PC.
  
  
  
  The use of VG during routine clinical conditions resulted in a modest reduction in the duration of HE (SpO2 <85%) and FiO2 compared to PC. The use of VG did not reduce the more severe HE.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Jain
authors.forename: Nelson
authors.initials: N
authors.lastname: Claure
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Ugard
authors.forename: Jose
authors.initials: J
authors.lastname: Bello
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bancalari
mesh_terms: D018592:Cross-Over Studies; D005431:Florida; D005865:Gestational Age; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010092:Oximetry; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume