Jain Deepak, Claure Nelson, D'Ugard Carmen, Bello Jose, Bancalari Eduardo
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Fla., USA.
Neonatology. 2016;110(2):129-34. doi: 10.1159/000444844. Epub 2016 Apr 19.
Preterm infants on mechanical ventilation have spontaneous hypoxemia episodes (HE) triggered by decreases in lung volume and tidal volume (VT). Volume guarantee (VG) is a mode where the ventilator peak pressure is adjusted to keep the exhaled VT at a target level. The effect of VG on HE under routine clinical conditions has not been fully evaluated.
To evaluate the effect of VG on HE in preterm infants in comparison to pressure control (PC) ventilation under routine clinical conditions.
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.
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.
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.
接受机械通气的早产儿会出现因肺容积和潮气量（VT）降低引发的自发性低氧血症发作（HE）。容量保证（VG）是一种通过调整呼吸机峰值压力以使呼出VT维持在目标水平的模式。在常规临床条件下，VG对HE的影响尚未得到充分评估。
在常规临床条件下，对比压力控制（PC）通气，评估VG对早产儿HE的影响。
纳入24例在8小时内动脉血氧饱和度（SpO2）≥4次低于75%的接受机械通气的早产儿。他们在连续2个24小时期间分别接受VG和PC治疗，顺序随机。
虽然HE（SpO2<85%持续≥20秒）的发作频率无差异，但在VG期间其持续时间缩短。PC和VG之间，严重HE（SpO2<75%持续≥20秒）的发作频率或持续时间无差异。VG期间严重低氧血症（SpO2<75%）的时间占比与PC无差异[中位数：4.4（四分位间距2.9 - 5.0）对5.0%（四分位间距3.9 - 6.9），p = 0.44]。与PC相比，VG期间的吸入氧分数（FiO2）更低。
在常规临床条件下使用VG，与PC相比，可适度缩短HE（SpO2<85%）的持续时间并降低FiO2。使用VG并不能减少更严重的HE。
