Pressure-Regulated Volume Control Ventilation vs Synchronized Intermittent Mandatory Ventilation for Very Low-Birth-Weight Infants

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, Dan- vers, Mass). Infants received their assigned mode of ven- tilation until extubation, death, or meeting predeter- mined 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 ex- tubated 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 in- fants receiving SIMV (33%) failed their assigned venti- lator mode than did infants receiving PRVC (20%). In- cluding 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, extu- bated, 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. Arch Pediatr Adolesc Med. 2005;159:868-875