What is Volume Targeted Ventilation?
Volume Targeted Ventilation (VTV) is a mode of mechanical ventilation where the ventilator delivers a preset tidal volume to the lungs. This technique is particularly useful in neonates, who are vulnerable to both overdistension and atelectasis due to their immature lungs. VTV aims to optimize lung volume while minimizing the risk of lung injury.
How Does VTV Work?
In VTV, the ventilator adjusts the pressure it uses to deliver a consistent tidal volume, based on the lung compliance and resistance of the neonate. The ventilator continuously monitors the delivered tidal volume and makes real-time adjustments to ensure the preset volume is delivered with each breath.
What are the Benefits of VTV?
1.
Reduced Lung Injury: By maintaining consistent tidal volumes, VTV reduces the risk of volutrauma and atelectotrauma.
2.
Improved Gas Exchange: Consistent tidal volumes lead to better alveolar ventilation and more stable gas exchange.
3.
Prevention of Hypercapnia and Hypocapnia: VTV helps in maintaining appropriate levels of carbon dioxide, reducing the risks associated with both high and low levels.
4.
Enhanced Respiratory Support: VTV is particularly beneficial for preterm infants who have underdeveloped lungs and are more susceptible to lung injury.
What are the Challenges of Implementing VTV?
1.
Technical Limitations: The effectiveness of VTV relies heavily on the accuracy of the ventilator's monitoring and adjustment capabilities. Inaccurate measurements can lead to inappropriate ventilation.
2.
Neonatal Variability: Neonates have rapidly changing lung mechanics, making it challenging to maintain the preset tidal volumes consistently.
3.
Training and Expertise: Effective use of VTV requires specialized training for healthcare providers to understand and manage the settings correctly.
What are the Indications for VTV in Neonates?
1.
Preterm Infants: VTV is particularly beneficial for very low birth weight and extremely low birth weight infants who are at high risk of lung injury.
2.
Neonatal Respiratory Distress Syndrome (RDS): VTV can help maintain optimal lung volumes and improve oxygenation.
3.
Bronchopulmonary Dysplasia (BPD): Infants at risk of or diagnosed with BPD can benefit from the lung-protective strategy of VTV.
4.
Post-Surgical Care: Neonates requiring ventilation post-surgery can benefit from the consistent tidal volumes provided by VTV.
Case Studies and Evidence
Numerous studies have demonstrated the benefits of VTV in reducing lung injury and improving outcomes in neonates. For instance, a study published in the Journal of Pediatrics showed that VTV reduced the incidence of BPD and improved overall survival rates in preterm infants. Another study in the Archives of Disease in Childhood found that VTV led to better long-term respiratory outcomes compared to traditional pressure-controlled ventilation.Conclusion
Volume Targeted Ventilation is a critical advancement in neonatal care, offering a safer and more effective way to provide mechanical ventilation to vulnerable infants. By maintaining consistent tidal volumes, VTV minimizes the risk of lung injury and improves respiratory outcomes. However, successful implementation requires careful monitoring, specialized training, and an understanding of the unique challenges posed by neonatal physiology.
