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Factors associated with initial tidal volume selection during neonatal volume-targeted ventilation in two NICUs: a retrospective cohort study

Journal of Perinatology volume 42, pages 756–760 (2022)Cite this article

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Abstract

Objective

To quantify initial tidal volume (VT) during neonatal volume-targeted ventilation (VTV) and to characterize the agreement of initial VT with the limited-evidence available.

Study design

We performed a multi-center retrospective observational cohort study in two Neonatal Intensive Care Units evaluating 313 infants who received VTV as the initial ventilation modality prior to postnatal day 14. We generated descriptive statistics and performed multivariable logistic regression analysis to determine factors associated with initial VT use that agreed with available literature.

Results

154 (49%) infants received an initial VT of 5.0 mL/kg (median 5.0 mL/kg, IQR 5.0–5.1). 45 (14%) infants received an initial VT that was congruent with available literature. A birth weight of 700 –<1250 g was significantly associated with an initial VT in agreement with VT literature (aOR 9.4, 95% CI 1.7–50.4).

Conclusions

Most infants receive an initial VT of 5.0 mL/kg.

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Fig. 1: Flow diagram of infants included in study.
Fig. 2: Initial tidal volumes.

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Data availability

A deidentified dataset and the Stata and R code used to clean the dataset may be shared with interested researchers upon request.

References

  1. Vendettuoli V, Bellu R, Zanini R, Mosca F, Gagliardi L.Italian Neonatal Network Changes in ventilator strategies and outcomes in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2014;99:F321–324.

    Article  Google Scholar 

  2. Laptook AR, O’Shea TM, Shankaran S, Bhaskar B, Network NN. Adverse neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antecedents. Pediatrics. 2005;115:673–80.

    Article  Google Scholar 

  3. Guillot M, Guo T, Ufkes S, Schneider J, Synnes A, Chau V, et al. Mechanical ventilation duration, brainstem development, and neurodevelopment in children born preterm: a prospective cohort study. J Pediatr. 2020;226:87–95.e83.

    Article  Google Scholar 

  4. Jensen EA, DeMauro SB, Kornhauser M, Aghai ZH, Greenspan JS, Dysart KC. Effects of multiple ventilation courses and duration of mechanical ventilation on respiratory outcomes in extremely low-birth-weight infants. JAMA Pediatr. 2015;169:1011–7.

    Article  Google Scholar 

  5. Islam JY, Keller RL, Aschner JL, Hartert TV, Moore PE. Understanding the short- and long-term respiratory outcomes of prematurity and Bronchopulmonary Dysplasia. Am J Respir Crit Care Med. 2015;192:134–56.

    Article  Google Scholar 

  6. Klingenberg C, Wheeler KI, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in neonates. Cochrane Database Syst Rev. 2017;10:CD003666.

    PubMed  Google Scholar 

  7. Gupta A, Keszler M. Survey of ventilation practices in the neonatal intensive care units of the United States and Canada: use of volume-targeted ventilation and barriers to its use. Am J Perinatol. 2018;36:484–9.

    PubMed  Google Scholar 

  8. Dawson C, Davies MW. Volume-targeted ventilation and arterial carbon dioxide in neonates. J Paediatr Child Health. 2005;41:518–21.

    Article  Google Scholar 

  9. Nassabeh-Montazami S, Abubakar KM, Keszler M. The impact of instrumental dead-space in volume-targeted ventilation of the extremely low birth weight (ELBW) infant. Pediatr Pulmonol. 2009;44:128–33.

    Article  Google Scholar 

  10. Keszler M, Nassabeh-Montazami S, Abubakar K. Evolution of tidal volume requirement during the first 3 weeks of life in infants <800 g ventilated with Volume Guarantee. Arch Dis Child Fetal Neonatal Ed. 2009;94:F279–282.

    Article  CAS  Google Scholar 

  11. Sharma S, Abubakar KM, Keszler M. Tidal volume in infants with congenital diaphragmatic hernia supported with conventional mechanical ventilation. Am J Perinatol. 2015;32:577–82.

    Article  Google Scholar 

  12. Sharma S, Clark S, Abubakar K, Keszler M. Tidal volume requirement in mechanically ventilated infants with meconium aspiration syndrome. Am J Perinatol. 2015;32:916–9.

    Article  Google Scholar 

  13. Keszler M. Volume-targeted ventilation: one size does not fit all. Evidence-based recommendations for successful use. Arch Dis Child Fetal Neonatal Ed. 2019;104:F108–F112.

    Article  Google Scholar 

  14. Dassios T, Dixon P, Hickey A, Fouzas S, Greenough A. Physiological and anatomical dead space in mechanically ventilated newborn infants. Pediatr Pulmonol. 2018;53:57–63.

    Article  Google Scholar 

  15. Hatch LD, Sala C, Araya W, Rivard M, Bolton J, Rivard A, et al. Increasing volume-targeted ventilation use in the NICU. Pediatrics. 2021;147:e20201500.

    Article  Google Scholar 

  16. Tarnow-Mordi W, Parry G. The CRIB score. Lancet. 1993;342:1365.

    Article  CAS  Google Scholar 

  17. te Pas AB, Kamlin CO, Dawson JA, O’Donnell C, Sokol J, Stewart M, et al. Ventilation and spontaneous breathing at birth of infants with congenital diaphragmatic hernia. J Pediatr. 2009;154:369–73.

    Article  Google Scholar 

  18. Henderson-Smart DJ, De Paoli AG, Clark RH, Bhuta T. High frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev. 2009;2009:CD002974.

    PubMed Central  Google Scholar 

  19. Hunt K, Dassios T, Ali K, Greenough A. Volume targeting levels and work of breathing in infants with evolving or established bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed. 2019;104:F46–f49.

    Article  Google Scholar 

  20. Abman SH, Collaco JM, Shepherd EG, Keszler M, Cuevas-Guaman M, Welty SE, et al. Interdisciplinary care of children with severe Bronchopulmonary Dysplasia. J Pediatr. 2017;181:12–28.e11.

    Article  Google Scholar 

  21. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl J Med. 2000;342:1301–8.

    Article  Google Scholar 

  22. Clark RH, Slutsky AS, Gerstmann DR. Lung protective strategies of ventilation in the neonate: what are they? Pediatrics. 2000;105:112–4. 1 Pt 1

    Article  CAS  Google Scholar 

  23. Lista G, Castoldi F, Fontana P, Reali R, Reggiani A, Bianchi S, et al. Lung inflammation in preterm infants with respiratory distress syndrome: effects of ventilation with different tidal volumes. Pediatr Pulmonol. 2006;41:357–63.

    Article  Google Scholar 

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Acknowledgements

We express our deepest gratitude to Steven Steele, Theresa Rogers, and Eva Dye, DNP who helped with research data collection for this study.

Funding

LAK received funding by the National Library of Medicine T15 LM007450 to perform this study. LDH was supported by the Vanderbilt Department of Pediatrics Turner-Hazinski Faculty Scholars Award and the Gerber Foundation. Use of the Research Electronic Data Capture program was supported by UL1 TR000445 from NCATS/NIH.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Iowa, Iowa City, IA, USA

    Lindsey A. Knake

  2. Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA

    Lindsey A. Knake, Mhd Wael Alrifai, Scott O. Guthrie & L. Dupree Hatch III

  3. Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA

    Lindsey A. Knake, Mhd Wael Alrifai, Allison B. McCoy & Adam Wright

  4. Vanderbilt Clinical Informatics Center, Vanderbilt University, Nashville, TN, USA

    Lindsey A. Knake, Mhd Wael Alrifai, Allison B. McCoy & Adam Wright

  5. Jackson-Madison County General Hospital, Jackson, TN, USA

    Scott O. Guthrie

  6. Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Christoph U. Lehmann

  7. Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA

    L. Dupree Hatch III

  8. Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA

    L. Dupree Hatch III

Authors
  1. Lindsey A. Knake
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  2. Mhd Wael Alrifai
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  3. Allison B. McCoy
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  4. Scott O. Guthrie
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  6. Christoph U. Lehmann
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  7. L. Dupree Hatch III
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Contributions

LAK, MWA, CUL, and LDH conceived this project and outlined the primary objectives for this manuscript. LAK and LDH extracted and reviewed the ventilator data and performed the data analyses. SOG implemented and extracted data from the Jackson-Madison NICU location. LAK, MWA, ABM, and AW assisted with data extraction and transformation of data extracted from the electronic health record. LAK, MWA, and LDH produced the first draft of the manuscript for publication. All authors critically appraised and approved the final submitted version of the manuscript.

Corresponding author

Correspondence to Lindsey A. Knake.

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The authors declare no competing interests.

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Knake, L.A., Alrifai, M.W., McCoy, A.B. et al. Factors associated with initial tidal volume selection during neonatal volume-targeted ventilation in two NICUs: a retrospective cohort study. J Perinatol 42, 756–760 (2022). https://doi.org/10.1038/s41372-022-01362-0

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