A preterm neonate born at 28 weeks gestation is intubated and ventilated for respiratory distress syndrome (RDS). Despite surfactant and ventilation, the PaCO2 is 68 mmHg and PaO2 is 48 mmHg (FiO2 0.6). Which ventilation strategy is most associated with improved outcomes in preterm RDS?
- A Volume-targeted ventilation (VTV) to reduce volutrauma and BPD risk ✓
- B High-frequency oscillatory ventilation (HFOV) as primary mode
- C Pressure-controlled intermittent mandatory ventilation (PCIMV) with permissive hypercapnia
- D Synchronized intermittent mandatory ventilation (SIMV) with high rates to normalize PaCO2
Explanation
Volume-targeted ventilation (VTV), where the ventilator delivers a set tidal volume (typically 4–6 mL/kg) by automatically adjusting pressure, reduces volutrauma and is associated with decreased rates of bronchopulmonary dysplasia (BPD), pneumothorax, and periventricular leukomalacia compared to pressure-limited ventilation. Meta-analyses including the Cochrane review show VTV reduces the composite outcome of death or BPD. HFOV is used as rescue therapy or for specific indications (air leak). Permissive hypercapnia (mild, pH >7.25) is accepted to minimize lung injury, but normalizing PaCO2 with high rates risks volutrauma.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.