Survey of Ventilation Practices in the Neonatal Intensive Care Units of the United States and Canada: Use of Volume-Targeted Ventilation and Barriers to Its Use

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 (V_T ) 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 V_T 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 V_T in a variety of common clinical scenarios among users of VTV.

Keywords

volume-targeted ventilation - tidal volume - volutrauma - practice variation

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