542 - Single center experience of volume targeted ventilation (VTV) for invasive chronic ventilation

Poster Number: 542
Publication Number: 542.242

Zena Ghazala, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Amit Agarwal, Arkansas Children's Hospital, Little Rock, AR, United States; Erhan Ararat, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; John L. Carroll, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States

Background: Children with chronic respiratory failure have improved survival and quality of life over the years due to advances in respiratory-related technologies. There is a paucity of evidence in the literature comparing ventilation strategies for long-term ventilation (LTV). Volume-targeted ventilation (VTV) combines control over the pressure and tidal volume (VT). It utilizes a goal VT through the delivery of a variable PIP in response to dynamic physiologic changes that occur in children. There are few case reports using non-invasive VTV in pediatrics, but no reports using VTV for invasive long-term mechanical ventilation so far in literature.

Objective: in this single-center report, we present our experience on the use of VTV via tracheostomy as a safe mode of ventilating children for long term at home

Design/Methods: In this retrospective chart review, we present the single-center experience of patients 0-21 years of age with new and established tracheostomies who were transitioned to LTV using VTV at our hospital between June 2018 and April 2021. The electronic health record was queried to identify patients. Patients who were on a ventilator for less than 4 weeks after tracheostomy placement were excluded. Patients were categorized into 4 groups based on their primary indication for ventilator needs: Bronchopulmonary dysplasia, neuromuscular disease, control of breathing, and airway anomalies.

Results: 27 patients were placed on VTV via tracheostomy for chronic ventilation. Table 1 shows the number of patients with different underlying primary causes for LTV. Eight patients were initially tried on another mode mainly SIMV PC/PS and later transitioned on to VTV due to difficulty tolerating other modes despite multiple attempts of adjusting ventilator settings. There were seven patients who tolerated the initial transition to pressure-controlled modes at home however had more difficulties later in their course leading to trialing a different mode. Twelve patients were transitioned directly to VTV.Conclusion(s): VTV was used in a broad range of age spectrum from infancy to adolscent, with multiple underlying diseases processes. Overall, it was well tolerated in our patients with no complications seen. VTV provides another strategy for chronic ventilation and needs further study. We acknowledge that that level of evidence is limited in this report due to the retrospective nature of data collection and having subjective outcome measures.
Table1. - Number of patients with Underlying Primary indication for requiring Long term ventilation via Volume Target ventilation VTV