Volume Guarantee Versus Manual Tidal Volume Monitoring During High-Frequency Oscillatory Ventilation in Neonates: A Pilot Randomized Controlled Trial.

Authors

Siddhavatam Rahul Karthik, Mohammad Yusuf Ali Mazhari, Mayank Priyadarshi, Poonam Singh, Suman Chaurasia, Nowneet Kumar Bhat, Sriparna Basu

Published in

Paediatric anaesthesia. Nov 12, 2026. Epub Nov 12, 2026.

Abstract

The present study compared the effects of high-frequency oscillatory ventilation (HFOV) with automated volume guarantee (HFOV-VG) versus careful manual high-frequency tidal volume (VThf) monitoring (HFOV-VM) on the incidences of hypo/hypercarbia in neonates.
In this open-labeled, parallel-group randomized controlled trial, 60 neonates failing conventional mechanical ventilation were allocated to receive HFOV-VG (n = 30) versus HFOV-VM (n = 30) as a rescue mode. The primary outcome was the incidence of hypo/hypercarbia at 1 h. Secondary outcomes were incidences of hypo/hypercarbia at 6/12/24/48 h and beyond, time-specific trends for partial pressure of carbon dioxide (pCO₂), delivered VThf and mean airway pressure (MAP), cerebral blood flow (CBF) in the anterior cerebral artery (ACA) and regional cerebral oxygenation (CrSO₂), duration of respiratory support, and incidences of in-hospital adverse events. Stata 18 was used for an intention-to-treat analysis.
The incidence of hypo- or hypercarbia at 1 h of intervention was 15/30 (50%) in the HFOV-VG and 13/30 (43%) in the HFOV-VM groups (p = 0.61). No differences were observed in the incidences of hypo- or hypercarbia anytime during HFOV. Time-specific pCO₂, VThf, and MAP were similar. On regression analysis, the only significant predictor for pCO₂ at 1 h was the baseline pCO₂ level in both the groups. No difference was observed in ACA-CBF, CrSO₂, duration of respiratory support, and in-hospital adverse events including mortality.
There was no difference in the incidence of hypo/hypercarbia with HFOV-VG versus HFOV-VM at 1 h and throughout the duration of ventilation with a similar rate of complications when used as a rescue therapy.
Clinical trial registry of India, Registration no: CTRI/2024/09/073455, Registered prospectively on 05/09/2024, https://ctri.icmr.org.in/.

PMID:
43016359
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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