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Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis
  1. WanSheng Peng1,
  2. HongWei Zhu1,
  3. Hua Shi1,
  4. EnMei Liu2
  1. 1Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, P.R. China
  2. 2Department of Respiratory Medicine, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China
  1. Correspondence to Peng WanSheng, Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Changhuai road 287, Bengbu 233004, P.R. China; PWS2007{at}126.com

Abstract

Objective To assess the effect of volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) in preterm infants.

Method We searched the Cochrane Library (Issue 3, 2013), PubMed (1966 to 5 March 2013), China National Knowledge Infrastructure (CNKI) and periodical databases (1979 to 5 March 2013). We selected randomised controlled trials (RCTs) and quasi-RCTs of VTV versus PLV as active interventions in preterm infants. We performed meta-analyses using the Cochrane statistical package RevMan 5.0.

Results Eighteen trials met our inclusion criteria. There was no evidence that VTV modes reduced the incidence of death (relative risk (RR) 0.73, 95% CI 0.51 to 1.05). The use of VTV modes resulted in a reduction in the incidence of bronchopulmonary dysplasia (BPD) (RR 0.61, 95% CI 0.46 to 0.82) and duration of mechanical ventilation (mean difference (MD) −2.0 days, 95% CI −3.14 to −0.86). VTV modes also resulted in reductions in intraventricular haemorrhage (IVH) (RR 0.65, 95% CI 0.42 to 0.99), grade 3/4 IVH (RR 0.55, 95% CI 0.39 to 0.79), periventricular leukomalacia (PVL) (RR 0.33, 95% CI 0.15 to 0.72), pneumothorax (RR 0.52, 95% CI 0.29 to 0.93), failure of primary mode of ventilation (RR 0.64, 95% CI 0.43 to 0.94), hypocarbia (RR 0.56, 95% CI 0.33 to 0.96), mean airway pressure (MD −0.54 cmH2O, 95% CI −1.05 to −0.02) and days of supplemental oxygen administration (MD −1.68 days, 95% CI −2.47 to −0.88).

Conclusions Preterm infants ventilated using VTV modes had reduced duration of mechanical ventilation, incidence of BPD, failure of primary mode of ventilation, hypocarbia, grade 3/4 IVH, pneumothorax and PVL compared with preterm infants ventilated using PLV modes. There was no evidence that infants ventilated with VTV modes had reduced death compared to infants ventilated using PLV modes.

  • Intensive Care
  • Neonatology

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