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September 2005

Pressure-Regulated Volume Control Ventilation vs Synchronized Intermittent Mandatory Ventilation for Very Low-Birth-Weight Infants: A Randomized Controlled Trial

Author Affiliations

Author Affiliations: Strong Children’s Research Center, University of Rochester, Rochester, NY (Drs D’Angio, Chess, Sinkin, Phelps, Kendig, Myers, and Ryan and Ms Reubens); Department of Pediatrics, Vassar Brothers Medical Center, Poughkeepsie, NY (Dr Kovacs); Department of Pediatrics, Hershey Medical Center/Pennsylvania State University, Hershey (Dr Kendig); and Children’s Hospital of Buffalo, State University of New York, Buffalo (Dr Ryan).

Arch Pediatr Adolesc Med. 2005;159(9):868-875. doi:10.1001/archpedi.159.9.868

Objective  To test the hypothesis that pressure-regulated volume control (PRVC), an assist/control mode of ventilation, would increase the proportion of very low-birth-weight infants who were alive and extubated at 14 days of age as compared with synchronized intermittent mandatory ventilation (SIMV).

Study Design  Ventilated infants with birth weight of 500 to 1249 g were randomized at less than 6 hours of age either to pressure-limited SIMV or to PRVC on the Servo 300 ventilator (Siemens Electromedical Group, Danvers, Mass). Infants received their assigned mode of ventilation until extubation, death, or meeting predetermined failure criteria.

Results  Mean ± SD birth weights were similar in the SIMV (888 ± 199 g, n = 108) and PRVC (884 ± 203 g, n = 104) groups. No differences were detected between SIMV and PRVC groups in the proportion of infants alive and extubated at 14 days (41% vs 37%, respectively), length of mechanical ventilation in survivors (median, 24 days vs 33 days, respectively), or the proportion of infants alive without a supplemental oxygen requirement at 36 weeks’ postmenstrual age (57% vs 63%, respectively). More infants receiving SIMV (33%) failed their assigned ventilator mode than did infants receiving PRVC (20%). Including failure as an adverse outcome did not alter the overall outcome (39% of infants in the SIMV group vs 35% of infants in the PRVC group were alive, extubated, and had not failed at 14 days).

Conclusion  In mechanically ventilated infants with birth weights of 500 to 1249 g, using PRVC ventilation from birth did not alter time to extubation.