Over the last three decades our view on mechanical ventilation of premature infants has changed significantly. Despite the rising interest and attention to non-invasive modes of ventilation, patients with the highest risk for poor pulmonary outcomes still require invasive ventilation. Synchronized- and patient-triggered ventilation has become a standard of care in premature infants. It remains unclear if one way of triggering of breath is superior to another. With the new emerging technologies such as NAVA high quality clinical trials are essential to address the advantages of one mode of breath triggering over the other. Existing data support the use of volume-targeted modes of ventilation over pressure-limited in premature infants. Despite these data, current surveys outside of the US fail to show that volumetargeted ventilation has become the main mode of ventilation in the NICUs. Well-designed survey study addressing the question why it is not used more widely would be very helpful. High frequency ventilation still remains a viable option to conventional ventilation. Although it is not superior to pressure-limited ventilation as a primary mode, the data support that it can be used safely. Lack of trials comparing HFV to volume-targeted ventilation makes the choice even more complicated. Multiple techniques exist to shorten the length of invasive mechanical ventilation. Use of synchronized ventilation, volume-targeted ventilation and post-extubation CPAP results in shortening length of ventilation and prevention of re-intubation. Although permissive hypercapnea and targeting lower oxygen saturation could be beneficial for reduction of ventilation length and improving pulmonary outcomes they should be used with caution due to concern of long-term neuro developmental complications.
Invasive Mechanical Ventilation in Premature Infants: Where do we Stand Today?: Sergei Roumiantsev
Journal of Pulmonary & Respiratory Medicine welcomes articles related to "Pediatric pulmonology journals"
Last date updated on July, 2014