Mechanical ventilation in neonates
- Eric C Eichenwald, MD
Eric C Eichenwald, MD
- Professor of Pediatrics
- Perelman School of Medicine, University of Pennsylvania
The introduction of mechanical ventilation in the 1960s was one of the major new interventions in neonatology, which provided lifesaving support for infants with respiratory failure. Along with other technologic advancements, such as the administration of antepartum corticosteroids and replacement surfactant therapy, mechanical ventilation has led to improved neonatal survival, especially for preterm infants born less than 30 weeks gestation with immature lung function. (See "Incidence and mortality of the preterm infant".)
Although mechanical ventilation can be lifesaving, it may cause chronic lung injury resulting in bronchopulmonary dysplasia (BPD), a major complication of prematurity. As a result, continued efforts have been focused upon development of new technology, including the use of early continuous positive airway pressure (CPAP) in preterm infants at risk for neonatal respiratory distress syndrome (RDS) and strategies for neonatal ventilator care to maintain adequate gas exchange but minimize lung damage. (See "Pathogenesis and clinical features of bronchopulmonary dysplasia" and "Prevention and treatment of respiratory distress syndrome in preterm infants", section on 'Nasal continuous positive airway pressure'.)
Neonatal ventilator care, including the different types of mechanical ventilation and their advantages and disadvantages, will be reviewed here. Non-invasive delivery of oxygen including nasal intermittent positive pressure ventilation is discussed separately. (See "Noninvasive oxygen delivery and oxygen monitoring in the newborn".)
Benefits — The principal benefits of neonatal mechanical ventilation during respiratory failure are as follows:
●Improve gas exchange, primarily by lung recruitment to improve ventilation/perfusion (V/Q) matching (see "Physiologic and pathophysiologic consequences of mechanical ventilation", section on 'Reduced shunt')
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- Indications for ventilation
- Types of ventilation
- CONVENTIONAL VENTILATION
- Types of conventional ventilators
- Ventilatory mode
- - Synchronized (patient-triggered) ventilation
- Modality: Pressure-limited or volume-targeted ventilation
- - Pressure-limited ventilation
- Advantages and disadvantages
- - Volume-targeted ventilation
- Advantages and disadvantages
- - Comparison between pressure- and volume-controlled ventilation
- HIGH-FREQUENCY VENTILATION
- Elective HFOV versus conventional ventilation
- Elective HFJV versus conventional ventilation
- Rescue HFV versus conventional ventilation
- OUR APPROACH
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS