Excerpt from Assisted Ventilation of the Newborn
Synonyms, Key Words, and Related Terms: assisted ventilation of the newborn, assisted ventilation of the neonate, respiratory support, breathing support, neonatal care, chronic lung disease, pulmonary mechanics, gas exchange, lung injury, control of breathing, conventional mechanical ventilation, CMV, hypercapnia, ventilation/perfusion, V/Q, hypoventilation, venoarterial shunts, apnea of prematurity, respiratory distress syndrome, RDS, high-frequency ventilation, HFV, hypoxemia, congenital cyanotic heart disease, patent ductus arteriosus, interstitial lung disease, gas trapping, metabolic acidosis, metabolic alkalosis
Hypercapnia is usually caused by severe ventilation/perfusion (V/Q) mismatch or hypoventilation. A substantial proportion of the increased survival rate of preterm infants during the last 30-40 years has been due to the availability of improved ventilatory support. The primary objective of assisted ventilation is to support breathing until the patient's respiratory efforts are sufficient. Ventilation may be required during immediate care of the infant who is depressed or apneic or during prolonged periods of respiratory failure treatment. Improved survival rates due to advances in neonatal care have resulted in an increased number of infants at risk for chronic lung disease. Although the etiology of lung injury is multifactorial, animal and clinical data indicate that lung injury is affected, in large part, by the ventilatory strategies used. Optimal ventilatory strategies provide the best possible gas exchange, with minimal or no lung injury or other adverse effects.
This article highlights the concepts of pulmonary mechanics, gas exchange, respiration control, and lung injury that can be used to optimize conventional mechanical ventilation (CMV) in order to optimize survival and to minimize adverse effects.
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