Volumetargeted

Volume-targeted ventilation (VTV), also called volume guarantee ventilation, is a mode of mechanical ventilation in which the ventilator aims to deliver a pre-set tidal volume on each breath. Rather than maintaining a fixed inspiratory pressure, the device adjusts peak inspiratory pressure to reach the target volume.

Operation: The ventilator measures the tidal volume of every inspiration and automatically increases or decreases the inspiratory pressure within preset safety limits to achieve the chosen target. In neonatology, target tidal volumes are commonly in the range of 4–6 mL per kilogram, with positive end-expiratory pressure (PEEP) and other settings managed separately.

Clinical use and evidence: Volume-targeted strategies strive to minimize volutrauma and ventilator-induced lung injury by avoiding excessive tidal volumes. In premature and newborn patients, randomized trials and meta-analyses have reported reduced rates of bronchopulmonary dysplasia and shorter ventilation duration compared with pure pressure-targeted strategies; in adults, usage is more variable.

Advantages and limitations: Advantages include more consistent tidal volumes, potentially reduced lung injury, and easier weaning from ventilation. Limitations include reliance on accurate tidal measurements that may be affected by leaks (e.g., endotracheal tube), changes in airway resistance or compliance, and the need for careful monitoring and calibration.

History and scope: The approach emerged with the development of volume-guarantee ventilator modes in the late 1990s and early 2000s. It is widely used in neonatal intensive care and remains an option in pediatric and adult intensive care in various settings.