“Current concepts of mechanical ventilation in neonates” – Part 1

Abstract

Mechanical ventilation is potentially live saving in neonatal patients with respiratory failure. The main purpose of mechanical ventilation is to ensure adequate gas exchange, including delivery of adequate oxygenation and enough ventilation for excretion of CO2. The possibility to measure and deliver small flows and tidal volumes have allowed to develop very sophisticated modes of assisted mechanical ventilation for the most immature neonates, such as volume targeted ventilation, which is used more and more by many clinicians. Use of mechanical ventilation requires a basic understanding of respiratory physiology and pathophysiology of the disease leading to respiratory failure. Understanding pulmonary mechanics, elastic and resistive forces (compliance and resistance), and its influence on the inspiratory and expiratory time constant, and the mechanisms of gas exchange are necessary to choose the best mode of ventilation and adequate ventilator settings to minimize lung injury. Considering the pathophysiology of the disease allows a physiology-based approach and application of these concepts in daily practice for decision making regarding the use of modes and settings of mechanical ventilation, with the ultimate aim of providing adequate gas exchange and minimising lung injury.

Bi-Level Positive Airway Pressure for Non-invasive Respiratory Support of Foals

“…Whereas, human neonates exhale passively ( 25 ), both inspiration and expiration are active processes, requiring muscular effort, in foals ( 26 ). Foals might therefore be predisposed to expiratory flow limitations and retention of CO 2 if active breathing strategies are unable to overcome expiratory pressures during CPAP, and the technique might be thus be associated increased intrinsic positive end-expiratory pressure (PEEPi) and alveolar overdistension, and hence predispose to hypercapnia.…”

Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case–control study

“…In our ventilated neonates, we implemented modern modes of mechanical ventilation with synchronized intermittent positive pressure ventilation (SIPPV), which has been shown to be associated with a shorter overall duration of ventilation in term neonates as compared to intermittent mandatory ventilation [49]. Nevertheless, more sophisticated methods of mechanical ventilation such as volume targeted ventilation are increasingly being used and have been shown to further improve clinical outcomes by allowing finer control of ventilated tidal volume [50,51]. Well controlled ventilation avoids the risk of volutrauma due to high tidal volume, reduces hypocarbia and risk of brain injury in case of frequent tidal volume fluctuations and avoids very low expired tidal volume that has been associated with atelectotrauma and hypercarbia [52].…”

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

“…The choice of conventional versus high-frequency ventilation is guided by the pathophysiology of the underlying disease and institutional practice. Depending on the neonatal respiratory disease static and dynamic compliance of the lungs, airway resistance, alveolar surface tension, work of breathing, and time constant may be very different [ 2 ]. This review article is focused on discussing the different modes and modalities of ventilation commonly used in neonatology.…”