Modalities of Mechanical Ventilation: Volume-Targeted Versus Pressure-Limited.

BACKGROUND: Respiratory distress syndrome remains the most common admission diagnosis in the neonatal intensive care unit. Healthcare providers have a clear appreciation for the potential harm to pulmonary structures that have been associated with mechanical ventilation (MV) in the preterm infant. Although life sustaining, the goal is to optimally ventilate while limiting trauma to the neonatal lung in order to preserve long-term cardiopulmonary and neurodevelopmental outcomes.

PURPOSE: To describe, compare, and contrast 2 primary methods of neonatal MV, pressure-limited ventilation (PLV) and volume-targeted ventilation (VTV), highlighting key considerations during therapy.

METHODS: A comprehensive search of the literature was completed using the following databases: CINAHL, Cochrane, Google Scholar, and PubMed. Research articles that were published in English over the last 10 years were reviewed for key information to describe and support the topic. Expert content review was conducted prior to publication by respiratory care providers, neonatal nurse practitioners, staff nurses, and neonatologist.

FINDINGS: Technology is rapidly evolving, with the newest mechanical ventilators providing the clinician with real-time data not previously available. Advanced microprocessors and feedback mechanisms can better support various ventilatory strategies including PLV and VTV. Renewed interest in volume ventilation has led many clinicians to ask about current evidence to support ventilatory modalities with regard to timing, settings, and short- and long-term effects.

IMPLICATIONS FOR PRACTICE: The clinician understands that neonatal pulmonary status is frequently changing based on gestational age, current age, and physiologic influences. Evidence supporting recommendations for the described MV modalities of PLV and VTV is provided for both preterm and term neonates.

IMPLICATIONS FOR RESEARCH: Comparison between MV strategies, specifically PLV and VTV, including short- and long-term neurodevelopmental outcomes, is needed. Recommendations regarding physiologic tidal volume for the extremely preterm infant are lacking.