Cerebral oxygenation and circulatory parameters during pressure-controlled vs volume-targeted mechanical ventilation in extremely preterm infants

Background. Respiratory distress syndrome (RDS) is the most common cause of respiratory failure of infants born prematurely with very low birth weight (VLBW). Essential elements of RDS management include ventilatory support and endotracheal administration of a surfactant. Objectives. To assess the effect of volume-targeted compared to pressure-controlled mechanical ventilation (MV) on circulatory parameters and cerebral oxygenation StO(2) in extremely preterm infants. Material and methods. This prospective, cross-over trial enrolled neonates born before 28 weeks of gestation. The patients were ventilated for 3 h in pressure-controlled assist-control (PC-AC) mode, followed by 3 h of volume-guarantee assist-control ventilation (VG-AC). Pulse oximetry (saturation (SpO(2)) and heart rate (HR)), near-infrared spectroscopy (NIRS), StO(2), and electrical cardiometry (EC) were used in monitoring of the patients. Results. Twenty preterm infants with a mean gestational age of 26 weeks were studied. The patients' mean postnatal age was 7.7 days. The SpO(2) values and HR were comparable during PC-AC and VG-AC. The mean values of peak inspiratory pressure (PIP), mean airway pressure (MAP) and expiratory tidal volume (VTE) were lower, while the respiratory rate (RR) was higher during PC-VG. There were no significant differences in the mean values of StO(2), but based on a comparison of the standard deviations (SD) the StO(2) variability was significantly lower during VG-AC. The circulatory parameters were comparable. Conclusions. The StO(2) is more stable during VG than PC ventilation. These findings support the use of VG mode in premature infants.