Volume guarantee ventilation in neonates treated with hypothermia for hypoxic-ischemic encephalopathy during interhospital transport

OBJECTIVE: We investigated if volume guarantee (VG) ventilation in babies with hypoxic-ischemic encephalopathy (HIE) during interhospital transport decreases tidal volumes and prevents hypocapnia. STUDY DESIGN: We computationally collected and analyzed ventilator data of babies ventilated with synchronized intermittent mandatory ventilation (SIMV) with VG (n = 28) or without VG (n = 8). RESULT: The expiratory tidal volume of ventilator inflations was lower with SIMV-VG (median [IQR]: 4.9 [4.6–5.3] mL/kg) than with SIMV only (median [IQR]: 7.1 [5.3–8.0] mL/kg, p = 0.01). Babies receiving SIMV-VG had lower peak inflating pressures (median: 10.7 cmH(2)O, versus 17.5 cmH(2)O, p = 0.01). There was no significant difference in minute ventilation or in pCO(2). Babies with strong spontaneous breathing had a mean PIP < 10 cmH(2)O but this did not result in adverse events or worsening of acidosis. CONCLUSIONS: The use of VG ventilation in babies with HIE reduces tidal volumes and frequently results in very low inflating pressures without affecting pCO(2).