Systematic Review and Meta-Analysis
Volume-Targeted versus Pressure-Limited Ventilation for Preterm Infants: A Systematic Review and Meta-AnalysisWheeler K.I.a–c · Klingenberg C.a, e, f · Morley C.J.a · Davis P.G.a, d
aNewborn Services, Royal Women’s Hospital, bMonash Institute for Medical Research, cMurdoch Children’s Research Institute, and dDepartment of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Vic., Australia; eDepartment of Paediatrics, University Hospital of North Norway, and fDepartment of Paediatrics, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
Dr. Kevin I. Wheeler
Newborn Services, Royal Women’s Hospital
Locked Bag 300, Cnr Grattan St/Flemington Road
Parkville, VIC 3052 (Australia)
Tel. +61 8345 3763, E-Mail email@example.com
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Background: The causes of bronchopulmonary dysplasia (BPD) are multifactorial. Overdistension of the lung (volutrauma) is considered an important contribution. As an alternative to traditional pressure-limited ventilation (PLV), modern neonatal ventilators offer modes which can target a set tidal volume. Objectives: To determine whether volume-targeted neonatal ventilation, compared with PLV, reduces death or BPD. Methods: We performed a systematic review and meta-analysis using the methodology of the Neonatal Review Group of the Cochrane Collaboration. A comprehensive literature search was undertaken, and data for prespecified outcomes were combined where appropriate using the fixed effects model. Results: Nine trials were eligible. Volume-targeted ventilation resulted in a reduction in: the combined outcome of death or BPD [typical relative risk, RR, 0.73 (95% confidence interval, 0.57–0.93), numbers needed to treat, NNT, 8 (95% CI 5–33)], the incidence of pneumothorax [typical RR 0.46 (95% CI 0.25–0.84), NNT 17 (95% CI 10–100)], days of ventilation [weighted mean difference 0.8 days (log-transformed data, p = 0.05)], hypocarbia (pCO2 <35 mm Hg/4.7 kPa); [typical RR 0.56 (95% CI 0.33–0.96), NNT 4 (95% CI 2–25)], and the combined outcome of periventricular leukomalacia or grade 3–4 intraventricular hemorrhage [typical RR 0.48 (95% CI 0.28–0.84), NNT 11 (95% CI 7–50)]. Conclusions: Compared with PLV, infants ventilated using volume-targeted ventilation had reduced death/BPD, duration of ventilation, pneumothoraces, hypocarbia and periventricular leukomalacia/severe intraventricular hemorrhage. Further studies are needed to assess neurodevelopmental outcomes.
© 2011 S. Karger AG, Basel
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