Abstract
Volutrauma is an important factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Our aims were to identify risk factors in the first 24h for prolonged ventilator dependence and assess volume delivery and carbon dioxide levels in infants with evolving BPD. A retrospective study was undertaken of 41 infants born at less than 32weeks of gestational age (GA). A higher tidal volume, minute volume and resistance and a lower GA, birth weight and compliance were associated with a significantly higher risk of ventilator dependence at 28days. The strongest relationships were with birth weight (area under the receiver operating characteristic curve, AUROC=0.771) and GA (AUROC=0.813). Tidal volume remained significantly higher after adjusting for GA in those who remained ventilator dependent at 28days. The 18 who remained ventilator dependent at 28days had increased mean carbon dioxide (PCO2) levels with increasing age from a mean of 41mmHg in the first 24h to 65mmHg at 28days PMA (p<0.001). The increase in PCO2 occurred despite increases in peak inflation pressures (p<0.001), tidal volumes (p=0.002) and minute volumes (p<0.001).Conclusion: These results suggest that initial volutrauma may contribute to the development of chronic ventilator dependence.