Volume-guaranteed Ventilation Versus Pressure-controlled Ventilation in Preterm Infants with Respiratory Distress Syndrome: A Randomized Controlled Trial

Background: This study was targeted toward comparing volume-guaranteed (VG) ventilation with conventional pressure-controlled (PC) ventilation in preterm infants with respiratory distress syndrome (RDS) in terms of the facilitation of weaning and extubation and occurrence of complications, such as pneumothorax, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC). Methods: This single-center randomized controlled trial was conducted on neonates who were mechanically ventilated in the Neonatal Intensive Care Unit of Kasturba Hospital Manipal Udupi, Karnataka, India. Infants with the gestational age (GA) of 27-34 weeks with RDS requiring mechanical ventilation in the first week of life were randomized to receive either SIMV-PC or SIMV-VG ventilation. Infants were stratified into two GA groups of 27-30 and 31-34 weeks. Sealed opaque envelope was used to randomize the infants into two treatment modalities. Sample size was calculated as 120 and 60 in each treatment group. Results: A total of 115 neonates were enrolled. The mean GA and birth weight of the treatment groups were 31±2.3 weeks and 1230±374 g, respectively, and 70% of them received antenatal steroids. As the primary outcome variable, the total duration of ventilation was 8 h (range: 3-17) (median and IQR) in the SIMV-PC group and 6 h (range: 3-13) in the SIMV-VG group (P=0.366). Stratified analysis of neonates with the GA of > 31-34 weeks showed a significant difference between the VG and PC ventilation groups regarding the duration of ventilation. Conclusion: There was a decrease in the duration of ventilation in VG ventilation, compared to that in PC ventilation at a higher GA. The leak was the major issue with VG ventilation in the lower GA group.