Mechanical Ventilation

Mechanical Ventilation of The Premature Neonate
Sussana Adjei
RSPT 2314
Mechanical Ventilation
Coleman College

Respiratory support is an essential part of care during clinical course of premature infants. Despite the trend in the NICU, the use of non-invasive modes of ventilation today on pre term neonates with lung disease are likely to require invasive mechanical ventilation. There have been a lot of studies on advantages and disadvantages on different modes of ventilation and strategies to assist neonates. Pediatric ventilation began with volume vents that delivered large pre-set tidal volumes of almost 18 mL/kg. In contrast, current ventilation for neonates is generally pressure regulated with much smaller tidal volumes
These modes became standard in the adult medical world before their introduction to the NICU. The technology was too limited to work with the very small patient effort created by infants. There was also concern about the creation of the extra weight and dead space that would be imposed on the endotracheal tube by the flow sensors. The eventual conclusion was that the accurate tidal volume measurements and the synchronization was worth the increase in dead space.
The next part of the article is discussing the differences between Continuous Mandatory Ventilation (CMV) and Synchronized Intermittent Mandatory Ventilation (SIMV). CMV is usually preferred when treating neonates because their breathing patterns can be unpredictable. CMV reduces the variability the tidal volume, reduces the weaning time and work of breathing and produces better ABG values.
Pressure Support Ventilation is seen to have positive results, especially when used with a mode like PC-CMV. It can help prevent gas trapping in infants with chronic lung disease and may help pre-term infants establish a breathing pattern that includes sighs, which they use to recruit and maintain their alveoli. All three of these modes of patient triggered ventilation have been seen to be better than PC-IMV, with reduced work of breathing, better synchrony with the vent and less weaning
The high rate of breathing and the small tidal volume create adequate minute ventilation while keeping airway pressures lower. The lower airway pressures are thought to reduce the rates of VILI. There are two types of HFV; High frequency oscillatory ventilation and high frequency jet ventilation. HFOV is a separate device. It uses a piston or vibrating diaphragm to produce the rapid, shallow bursts of air. There is also a continuous flow to clear the carbon dioxide from the lungs. With HFOV, exhalation is