Mechanical ventilation in the extreme premature newborn, where we are going?
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Date
2021
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Publisher
Palgrave Macmillan
Abstract
Extremely preterm infants frequently require mechanical ventilation (MV). In recent years, a wide variety of ventilators have been developed that provide different modes and precise information on the volumes they deliver, allowing health professionals to optimize ventilation and level of support. The objective of this review is to describe different ventilatory practices in preterm infants.
There are many modalities and their clinical utility has not been well evaluated in large controlled studies and various questions remain unresolved. It is clear that they allow optimize and reduce MV duration, which could reduce lung damage. However, their effects on improving outcomes such as bronchopulmonary dysplasia (BPD) and/or death are not so clear. It becomes necessary to have a greater number of controlled studies that provide solid evidence in order to recommend a specific modality.
In our experience, we try to use MV as little as possible by attempting a quick extubation. In these cases we use the synchronized intermitent mechanical ventilation + pressure support (SIMV+VPS) mode. In those sicker and/or smaller infants who we believe will require MV for a longer time, we prefer to use the assist control AC mode. In both situations ideally with the addition of volume guarantee. Once the patient has stabilized and presents spontaneous respiration, extubation should be considered, usually to CPAP, after loading with methylxanthines. Extubation to S-NIPPV can also be considered in centers that have possibilityofsynchronized mode.
Since there are several modalities and types of ventilators, it is recommended that within a unit, a selection be made in order for the clinical team to become familiar with their use.
There are many modalities and their clinical utility has not been well evaluated in large controlled studies and various questions remain unresolved. It is clear that they allow optimize and reduce MV duration, which could reduce lung damage. However, their effects on improving outcomes such as bronchopulmonary dysplasia (BPD) and/or death are not so clear. It becomes necessary to have a greater number of controlled studies that provide solid evidence in order to recommend a specific modality.
In our experience, we try to use MV as little as possible by attempting a quick extubation. In these cases we use the synchronized intermitent mechanical ventilation + pressure support (SIMV+VPS) mode. In those sicker and/or smaller infants who we believe will require MV for a longer time, we prefer to use the assist control AC mode. In both situations ideally with the addition of volume guarantee. Once the patient has stabilized and presents spontaneous respiration, extubation should be considered, usually to CPAP, after loading with methylxanthines. Extubation to S-NIPPV can also be considered in centers that have possibilityofsynchronized mode.
Since there are several modalities and types of ventilators, it is recommended that within a unit, a selection be made in order for the clinical team to become familiar with their use.
Description
Keywords
Mechanical Ventilation, Preterm Infants, Volume-Targeted Ventilation, INTERMITTENT MANDATORY VENTILATION, EXTREMELY PRETERM INFANTS, RESPIRATORY-DISTRESS-SYNDROME, CONTROLLED-TRIAL, INSPIRED OXYGEN, PRESSURE, FLUCTUATIONS, EXTUBATION, CROSSOVER, OUTCOMES