Abstract:
BACKGROUND:The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume. OBJECTIVES:To determine whether volume-targeted neonatal ventilation, compared with PLV, reduces death or BPD. METHODS:We performed a systematic review and meta-analysis using the methodology of the Neonatal Review Group of the Cochrane Collaboration. A comprehensive literature search was undertaken, and data for prespecified outcomes were combined where appropriate using the fixed effects model. RESULTS:Nine trials were eligible. Volume-targeted ventilation resulted in a reduction in: the combined outcome of death or BPD [typical relative risk, RR, 0.73 (95% confidence interval, 0.57-0.93), numbers needed to treat, NNT, 8 (95% CI 5-33)], the incidence of pneumothorax [typical RR 0.46 (95% CI 0.25-0.84), NNT 17 (95% CI 10-100)], days of ventilation [weighted mean difference 0.8 days (log-transformed data, p = 0.05)], hypocarbia (pCO(2) <35 mm Hg/4.7 kPa); [typical RR 0.56 (95% CI 0.33-0.96), NNT 4 (95% CI 2-25)], and the combined outcome of periventricular leukomalacia or grade 3-4 intraventricular hemorrhage [typical RR 0.48 (95% CI 0.28-0.84), NNT 11 (95% CI 7-50)]. CONCLUSIONS:Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
journal_name
Neonatologyjournal_title
Neonatologyauthors
Wheeler KI,Klingenberg C,Morley CJ,Davis PGdoi
10.1159/000326080subject
Has Abstractpub_date
2011-01-01 00:00:00pages
219-27issue
3eissn
1661-7800issn
1661-7819pii
000326080journal_volume
100pub_type
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