“Current concepts in assisted mechanical ventilation in the neonate” - Part 2

Abstract

Mechanical ventilation is a lifesaving intervention in critically ill preterm and term neonates. However, it has the potential to cause significant damage to the lungs resulting in long-term complications. Understanding the pathophysiological process and having a good grasp of the basic concepts of conventional and high-frequency ventilation is essential for any medical or allied healthcare practitioner involved in the neonates' respiratory management. This review aims to describe the various types and modes of ventilation usually available in neonatal units. It also describes recommendations of an individualized disease-based approach to mechanical ventilation strategies implemented in the authors' institutions.

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

“…The basic principle of pressure-targeted ventilation is to create enough pressure to open the airway, overcome the respiratory tract and lung parenchyma's resistance, and finally, result in the gas flow to the alveoli. The gas volume that reaches the alveoli depends on lung compliance, inspiratory pressure and time, flow, and synchronization of the ventilator with the baby's spontaneous breaths [10].…”

“…VTV is the most widely used invasive ventilation mode in premature neonates due to its apparent benefits in reducing mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and length of time on mechanical ventilation. The tidal volume setting can vary between 4 and 12 ml/kg in different disease states due to differences in underlying pathology, lung compliance, and resistance [10,13], although the higher tidal volumes are associated with increased morbidities.…”

“…Desirable tidal volumes for weaning are still debated and depend on numerous factors such as gestational age and disease state. During weaning, using low-volume settings in VTV while decreasing the ventilator rate increases the work of breathing; therefore, a tidal volume of 5-7 ml/kg is recommended [10].…”

Tecnologías y estrategias de ventilación mecánica en anestesia para pacientes pediátricos

“…Ventilar implica un trabajo respiratorio o WOB (work of breathing) que requiere un gasto de energía [11]. El WOB es proporcional a la fuerza generada para vencer la resistencia y las fuerzas elásticas que se oponen a la expansión pulmonar y al flujo de gas que se moviliza [12], [13] y se expresa como: WOB = Presión x Volumen o como el área bajo la curva de la curva Presión -Volumen.…”

A Comparative Study on Predication of Appropriate Mechanical Ventilation Mode through Machine Learning Approach

“…After intubation, the first step is to select an appropriate ventilation mode. Thus, ventilation mode is one of the most important ventilator settings [ 1 ]. The ventilator interprets the user’s instructions and then produces a series of breaths with the right volume, flow and pressure of air and oxygen.…”