Recent Advances in Neonatal Mechanical Ventilation?

Abstract

Conventional time cycled, pressure-limited ventilation has been used in neonatal intensive care units for many years. Meta-analysis of randomised trials demonstrated that conventional ventilation at rates of at least 60 breaths per minute rather than at slower rates significantly reduced the risk of airleak. Patient triggered ventilation more successfully than conventional ventilation promotes synchronous ventilation; nevertheless, randomised trials demonstrated the only advantage of patient triggered ventilation was that it was associated with a shorter duration of ventilation. More sophisticated triggered modes, pressure support, volume guarantee and proportional assist ventilation, have been developed. Results from physiological studies suggest these modes may be advantageous, but they have not been tested in large randomised controlled trials with long-term outcomes. Many anecdotal studies report avoidance of intubation and mechanical ventilation by use of continuous positive airways pressure reduces bronchopulmonary dysplasia, but the randomized trials which have been undertaken have been too small to appropriately address that outcome. Prophylactic high frequency oscillatory ventilation has been examined in many trials, but overall no benefit or disadvantage has been demonstrated. In conclusion, studies to date have not identified a clear advantage of any of the newer ventilation modes.