PT  - JOURNAL ARTICLE
AU  - Olivia Farrell
AU  - Elizabeth J Perkins
AU  - Don Black
AU  - Martijn Miedema
AU  - Joel Don Paul
AU  - Prue M Pereira-Fantini
AU  - David Gerald Tingay
TI  - Volume guaranteed? Accuracy of a volume-targeted ventilation mode in infants
AID  - 10.1136/archdischild-2017-312640
DP  - 2018 Mar 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F120--F125
VI  - 103
IP  - 2
4099  - http://fn.bmj.com/content/103/2/F120.short
4100  - http://fn.bmj.com/content/103/2/F120.full
SO  - Arch Dis Child Fetal Neonatal Ed2018 Mar 01; 103
AB  - Objectives Volume-targeted ventilation (VTV) is widely used and may reduce lung injury, but this assumes the clinically set tidal volume (VTset) is accurately delivered. This prospective observational study aimed to determine the relationship between VTset, expiratory VT (VTe) and endotracheal tube leak in a modern neonatal ­volume-targeted ventilator (VTV) and the resultant partial arterial pressure of carbon dioxide (PaCO2) relationship with and without VTV.Design Continuous inflations were recorded for 24 hours in 100 infants, mean (SD) 34 (4) weeks gestation and 2483 (985) g birth weight, receiving synchronised mechanical ventilation (SLE5000, SLE, UK) with or without VTV and either the manufacturer’s V4 (n=50) or newer V5 (n=50) VTV algorithm. The VTset, VTe and leak were determined for each inflation (maximum 90 000/infant). If PaCO2 was sampled (maximum of 2 per infant), this was compared with the average VTe data from the preceding 15 min.Results A total of 7 497 137 inflations were analysed. With VTV enabled (77 infants), the VTset−VTe bias (95% CI) was 0.03 (−0.12 to 0.19) mL/kg, with a median of 80% of VTe being ±1.0 mL/kg of VTset. Endotracheal tube leak up to 30% influenced VTset−VTe bias with the V4 (r2=−0.64, p<0.0001; linear regression) but not V5 algorithm (r2=0.04, p=0.21). There was an inverse linear relationship between VTe and PaCO2 without VTV (r2=0.26, p=0.004), but not with VTV (r2=0.04, p=0.10), and less PaCO2 within 40–60 mm Hg, 53% versus 72%, relative risk (95% CI) 1.7 (1.0 to 2.9).Conclusion VTV was accurate and reliable even with moderate leak and PaCO2 more stable. VTV algorithm differences may exist in other devices.