Comparison of Bilevel Volume Guarantee and Pressure-Regulated Volume Control Modes in Preterm Infants

Abstract Purpose: The present study aimed to compare the bilevel VG and PRVC modes of the GE® Carescape R860 model ventilator and test the safety and utility of these two modes in preterm neonates. Mehtods: Infants who were less than 30 weeks of gestational age, required intubation and mechanical ventilation in the first 24 hours of life, received surfactant at least once, and were clinically stable at postnatal 24 hours were included in the study. After randomization, initial ventilator settings were adjusted for each patient and recorded as the starting point. After the first 2 hours of ventilation, the patients were switched to the other ventilator mode for 2 hours. Ventilator parameters, vital signs, and blood gas values were evaluated at the beginning of the study, after the first ventilation mode, and after the second ventilation mode.Results: The study included a total of 28 patients, 14 in the PRVC group and 14 in the bilevel VG group. The mean birth weight was 876 g (range: 530-1170) and the mean gestational age was 26.4 weeks (range: 24-29). The patients’ peak inspiratory pressure (PIP2 and PIP3) was lower after ventilation in bilevel VG mode than in PRVC mode (13 vs. 14 cmH2O, respectively; paired samples t-test, p=0.008). After 2 hours of bilevel VG ventilation, mean heart rate decreased from 149/min to 140/min (p=0.001) and oxygen saturation increased from 91% to 94% (p=0.01). There were no significant differences in mean airway pressure, respiratory rate, or blood gas values. Conclusion: Both the PRVC and bilevel VG modes of GE ventilators can be used safely in preterm infants, and although the difference may not be very pronounced, bilevel VG mode was associated with more favorable early clinical findings. Studies including more patients and comparing with other modes will clarify and provide further evidence on this subject.Trial registration number: NCT04191239