Volume-controlled intermittent mandatory ventilation in preterm infants with hypoxemic episodes

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Abstract
To test the hypothesis in ventilated very low birth weight infants with frequent hypoxemic episodes that volume-controlled synchronized intermittent mandatory ventilation (SIMV) vs. pressure-controlled SIMV reduces by at least 20% the time with hypoxemia (defined as SpO2< 80%). Randomized cross-over design. University-based tertiary neonatal intensive care unit. 15 mechanically ventilated very low birth weight infants with frequent hypoxemic episodes. The infants were exposed in random order to volume-controlled and pressure-controlled SIMV for 4 h each. The target tidal volume during volume-controlled SIMV was matched to the tidal volume measured during pressure-controlled SIMV. FIO2 was adjusted using uniform criteria to maintain SpO2 within the target range (SpO2 80–92%). Primary outcome measure was the time with an SpO2< 80%. Although tidal volume was maintained better during desaturations with volume-controlled SIMV, there was neither a significant difference in time with an SpO2< 80% (expressed as proportion of total experimental time; median, interquartile range)—volume-control 10.6% (9.2–13.7%) vs. pressure-control 10.8% (8.3–13.3%)—nor in FIO2 exposure. During volume-controlled SIMV the infants spent less time with an SpO2 above the target range and had fewer associated bradycardias. Volume-controlled SIMV did not decrease the time with an SpO2< 80%, although tidal volume was better maintained during these episodes and bradycardias were less frequent than with pressure-controlled SIMV in this population of very low birth weight infants with frequent hypoxemic episodes.