Background and aim Evidence suggests that volume targeted ventilation improves short-term outcomes in preterm infants.1 Change of practice to using volume targeted ventilation as the default mode was instituted at a tertiary level neonatal unit following a program of education and training. The aim of this quality improvement project was to evaluate the safety of this transition by studying short- term respiratory and other clinical outcomes.
Methods This was a retrospective review of neonates born between Dec 2010 to April 2012, at < 29 weeks gestational age and birth weight <1500 grams. A new guideline was published and staff training sessions were undertaken prior to a single date switch over (1 Oct 2011) of the ventilation strategy.
Infants requiring non-invasive ventilation at birth or who were admitted from other hospitals older than one day were excluded. Continuous variables were compared using Students T-test, categorical variables by chi-squared test.
Results Lecture based, small group and bedside teaching sessions were undertaken. 46 infants (volume ventilation = 23) were studied. Demographic-data for antenatal variables and short-term outcomes were measured.
Mean birth weight (0.79 vs. 0.92 Kg), male sex (13 vs. 14), gestation (25.3 vs. 26.7 w), Apgar score <5 at 1 min (8 vs. 5) were not different between the pressure and volume targeted groups respectively (p > 0.05).
The average mean airway pressure in the first 72 h (7.8 vs. 7.7 cm H2O), time to first extubation (24 vs. 33 h), lowest PaCO2 in the first 72 h (4.1 vs. 4.0 kPa), rate of grade III to IV intraventricular haemorrhage (4 vs. 6), pneumothorax (0 vs. 1), and BPD defined as oxygen dependency at 36w (4 vs. 6) were not significantly different (p > 0.05). No adverse incidents were noted.
Conclusion Following a change over to volume targeted ventilation there was no change in short- term outcomes or any increase in adverse incidents noted. An intensive and targeted training program may have helped achieving a safe transition.
Wheeler K, et al. Cochrane Database of Systematic Reviews, 2010(11)