Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis

作者：Wansheng Peng, Hongwei Zhu, Hua Shi, Enmei Liu · 发表于：Archives of Disease in Childhood Fetal & Neonatal · 年份：2013 · DOI：10.1136/archdischild-2013-304613 · 被引用次数：137 · 研究领域：Neonatal Respiratory Health Research、Respiratory Support and Mechanisms、Neuroscience of respiration and sleep

OBJECTIVE: To assess the effect of volume-targeted ventilation (VTV) compared with pressure-limited ventilation (PLV) in preterm infants. METHOD: We searched the Cochrane Library (Issue 3, 2013), PubMed (1966 to 5 March 2013), China National Knowledge Infrastructure (CNKI) and periodical databases (1979 to 5 March 2013). We selected randomised controlled trials (RCTs) and quasi-RCTs of VTV versus PLV as active interventions in preterm infants. We performed meta-analyses using the Cochrane statistical package RevMan 5.0. RESULTS: Eighteen trials met our inclusion criteria. There was no evidence that VTV modes reduced the incidence of death (relative risk (RR) 0.73, 95% CI 0.51 to 1.05). The use of VTV modes resulted in a reduction in the incidence of bronchopulmonary dysplasia (BPD) (RR 0.61, 95% CI 0.46 to 0.82) and duration of mechanical ventilation (mean difference (MD) -2.0 days, 95% CI -3.14 to -0.86). VTV modes also resulted in reductions in intraventricular haemorrhage (IVH) (RR 0.65, 95% CI 0.42 to 0.99), grade 3/4 IVH (RR 0.55, 95% CI 0.39 to 0.79), periventricular leukomalacia (PVL) (RR 0.33, 95% CI 0.15 to 0.72), pneumothorax (RR 0.52, 95% CI 0.29 to 0.93), failure of primary mode of ventilation (RR 0.64, 95% CI 0.43 to 0.94), hypocarbia (RR 0.56, 95% CI 0.33 to 0.96), mean airway pressure (MD -0.54 cmH2O, 95% CI -1.05 to -0.02) and days of supplemental oxygen administration (MD -1.68 days, 95% CI -2.47 to -0.88). CONCLUSIONS: Preterm infants ventilated using VTV mo...