Ashish Gupta1, Martin Keszler1. 1. Department of Pediatrics, Warren Alpert Medical School, Women and Infants Hospital, Brown University, Providence, Rhode Island.
Abstract
OBJECTIVE: To provide current data on ventilation practices and use of volume-targeted ventilation (VTV) in neonatal intensive care units of the United States and Canada, to identify the perceived barriers to the implementation of VTV, and to assess the knowledge base of appropriate initial tidal volume (VT ) settings for different hypothetical clinical scenarios. STUDY DESIGN: This was a cross-sectional online survey of individual neonatologists practicing in the United States and Canada. RESULTS: We received 387 responses (estimated response rate: ∼20%). Use of VTV was much higher in Canada (81%) compared with 39% in the United States. In the United States, VTV use is highest in the Northwest at 77% and lowest in the Northeast at 32.5%. The chief barrier to use of VTV was lack of knowledge about VTV and lack of appropriate equipment. The five clinical scenarios revealed that the majority of responders failed to select appropriate evidence-based VT for the specific scenario. CONCLUSION: Pressure-controlled ventilation remains the predominant approach to neonatal ventilation in the United States, while VTV is the preferred mode in Canada. Despite available data and important pathophysiological differences between patients, there is insufficient understanding of how to choose an appropriate VT in a variety of common clinical scenarios among users of VTV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
OBJECTIVE: To provide current data on ventilation practices and use of volume-targeted ventilation (VTV) in neonatal intensive care units of the United States and Canada, to identify the perceived barriers to the implementation of VTV, and to assess the knowledge base of appropriate initial tidal volume (VT ) settings for different hypothetical clinical scenarios. STUDY DESIGN: This was a cross-sectional online survey of individual neonatologists practicing in the United States and Canada. RESULTS: We received 387 responses (estimated response rate: ∼20%). Use of VTV was much higher in Canada (81%) compared with 39% in the United States. In the United States, VTV use is highest in the Northwest at 77% and lowest in the Northeast at 32.5%. The chief barrier to use of VTV was lack of knowledge about VTV and lack of appropriate equipment. The five clinical scenarios revealed that the majority of responders failed to select appropriate evidence-based VT for the specific scenario. CONCLUSION: Pressure-controlled ventilation remains the predominant approach to neonatal ventilation in the United States, while VTV is the preferred mode in Canada. Despite available data and important pathophysiological differences between patients, there is insufficient understanding of how to choose an appropriate VT in a variety of common clinical scenarios among users of VTV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Lindsey A Knake; Mhd Wael Alrifai; Allison B McCoy; Scott O Guthrie; Adam Wright; Christoph U Lehmann; L Dupree Hatch Journal: J Perinatol Date: 2022-03-12 Impact factor: 3.225