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NeoReviews Vol.7 No.5 2006 e250
© 2006 American Academy of Pediatrics

Volume-targeted Ventilation

^* Professor of Pediatrics, Georgetown University, Washington DC

Abbreviations: AC: assist control • PEEP: positive end-expiratory pressure • PIP: peak inspiratory pressure • PSV: pressure support ventilation • PRVC: pressure-regulated volume control • RDS : respiratory distress syndrome • SIMV: synchronized intermittent mandatory ventilation • VAPS: volume-assured pressure support • VG: volume guarantee

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Understand the importance of controlling tidal volume and avoiding hyperventilation/excessive tidal volume.
   
2. Recognize the importance of optimizing lung inflation and avoiding atelectasis.
   
3. Delineate the limitations of traditional volume-controlled ventilation in newborns.
   
4. Describe the various modes of volume-targeted ventilation and their advantages and disadvantages.
   
5. Describe the key steps in the clinical application of volume guarantee ventilation.
   

	Introduction

 
Mechanical ventilation has improved to the point where few infants die because of acute respiratory failure. Mortality now is predominantly from other complications of extreme prematurity, such as infection, necrotizing enterocolitis, and intracranial hemorrhage. Consequently, focus has shifted from merely reducing mortality to reducing the incidence of chronic lung disease, which has increased in recent years with improved survival of extremely preterm infants.

Although high-frequency ventilation has shown promise, results of clinical trials have been inconsistent, and continued concerns about the hazards of inadvertent hyperventilation have limited its acceptance as first-line therapy in infants who have uncomplicated respiratory distress syndrome (RDS). At the same time, technologically advanced synchronized ventilation has become widely available. The most exciting development in neonatal respiratory support, however, is the advent of volume-targeted modalities of conventional ventilation that, for the first time, allow effective control of delivered tidal volume for neonatal ventilation.

	Rationale for Volume-targeted Ventilation

 
Pressure-limited, time-cycled, continuous flow ventilation has been the standard of care in neonatal ventilation for more than 30 years. One of the advantages cited for the preference for pressure-limited over volume-controlled ventilation has been the ability to control the inspiratory pressure directly. Preoccupation with high inspiratory pressure as the chief culprit in lung injury and air leak has been a constant theme in neonatal respiratory support until recently, despite accumulating evidence over more than a decade that volume, rather than pressure, is the critical determinant of ventilator-induced lung injury. Dreyfuss . . . [Full Text of this Article]