Volume Guarantee Ventilation: Effect on Preterm Infants with Frequent Hypoxemia Episodes.

Background: Preterm infants on mechanical ventilation have spontaneous hypoxemia episodes (HE) triggered by decreases in lung volume and tidal volume (V T ). Volume guarantee (VG) is a mode where the ventilator peak pressure is adjusted to keep the exhaled V T at a target level. The effect of VG on HE under routine clinical conditions has not been fully evaluated. Objective: To evaluate the effect of VG on HE in preterm infants in comparison to pressure control (PC) ventilation under routine clinical conditions. Methods: Twenty-four mechanically ventilated preterm infants with ≥ 4 HE of arterial oxygen saturation (SpO₂) <75% over 8 h were enrolled. They were studied over 2 consecutive 24-hour periods of VG and PC, in random order. Results: While the frequency of HE (SpO₂ <85% for ≥ 20 s) did not differ, their duration was reduced during VG. The frequency or duration of severe HE (SpO₂ <75% for ≥ 20 s) did not differ between PC and VG. The proportion of time in severe hypoxemia (SpO₂ <75%) during VG did not differ from PC [median: 4.4 (IQR 2.9-5.0) vs. 5.0% (IQR 3.9-6.9), p = 0.44]. The fraction of inspired oxygen (FiO₂) was lower during VG compared to PC. Conclusion: The use of VG during routine clinical conditions resulted in a modest reduction in the duration of HE (SpO₂ <85%) and FiO₂ compared to PC. The use of VG did not reduce the more severe HE. [ABSTRACT FROM AUTHOR]