Conventional Ventilation

Videos and Lectures

• Dr. Null on Conventional
  Neonatal Ventilation
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Research Papers

• Patient-ventilator interactions in new modes of patient triggered ventilation-Abubakar

  Mechanical ventilation has improved to the point where few infants die because of acute respiratory failure. Mortality now is predominantly from other complications of extreme prematurity, such as infection, necrotizing enterocolitis, and intracranial hemorrhage.

• Effects of volume-guaranteed synchronized intermittent mandatory ventilation in preterm infants recovering from respiratory failure-Herrera

  The objective of this study was to compare the effects of SIMV+VG with conventional SIMV on ventilation and gas exchange in a group of very low birth weight infants recovering from acute respiratory failure.

• Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation-Olsen

  By Permission: from Macmillan Publishers Ltd: Journal of Perinatology 2002;22(6):461-466. Copyright 2002.
  To compare pressure support ventilation (PSV) with volume guarantee (VG) to synchronized intermittent mandatory ventilation (SIMV) in infants with respiratory distress syndrome (RDS).

• Feasibility of tidal volume-guided ventilation in newborn infants-a randomized, crossover trial using the volume guarantee modality-Cheema

  This study aimed to investigate the feasibility and efficacy of this mode of ventilation in premature newborn infants with respiratory distress syndrome (RDS).

• Is there an advantage of using pressure support ventilation with volume guarantee in the initial management of premature infants with respiratory distress syndrome-Nafday

  By Permission: from Macmillan Publishers Ltd: Journal of Perinatology 2005;25:193–197. Copyright 2005.
  To evaluate the feasibility of using the pressure support ventilation with volume guarantee (PSV-VG) as an initial ventilatory mode in preterm infants with respiratory distress syndrome (RDS) after surfactant treatment to achieve accelerated weaning of peak inspiratory pressure (PIP) and mean airway pressure (MAP).

• Pressure support ventilation combined with volume guarantee versus synchronized intermittent mandatory ventilation-Abd El-Moneim

  To compare pressure support ventilation combined with volume guarantee (PSV-VG) to synchronized intermittent mandatory ventilation (SIMV) regarding safety, course of blood gases, and infant-ventilator interaction in premature infants.

• Effect of volume guarantee combined with assist-control vs. synchronized intermittent mandatory ventilation-Abubakar

  During volume guarantee (VG) ventilation the peak inflating pressure (PIP) for each ventilator inflation is adjusted to ensure the expired tidal volume (V_Te) is close to the set V_Te. Differences in the PIP between inflations triggered by the infant’s inspirations and untriggered inflations are seen.

• Volume-targeted ventilation and arterial carbon dioxide in neonates-Dawson

  To review the arterial carbon dioxide tensions (PaCO_2,) in newborn infants ventilated using the synchronized intermittent mandatory ventilation (SIMV) in volume guarantee mode (using the Draeger Babylog 8000+) with a unit policy targeting tidal volumes of approximately 4mL/kg.

• Volume guarantee ventilation, interrupted expiration and expiratory braking-McCallion

  To investigate interrupted expiration observed during volume guarantee ventilation of spontaneously breathing, ventilated infants.

• Volume-targeted versus pressure-limited ventilation in the neonate-McCallion

  Inflammation caused by lung overdistension (volutrauma) is thought to be important in the pathogenesis of bronchopulmonary dysplasia (BPD). Preterm infants with variable lung compliance are particularly at risk.

• Effects of pressure support ventilation plus volume guarantee vs high-frequency oscillatory ventilation on lung inflammation in preterm infants-Dani

  Appropriate ventilation together with improvement of clinical care of premature babies can contribute to reducing lung inflammation, known to represent the “primum movens” of bronchopulmonary dysplasia (BPD).

• Lung inflammation in preterm infants with respiratory distress syndrome-effects of ventilation with different tidal volumes

  Ventilation with an inappropriate tidal volume (V_T) triggers lung inflammation, an important predisposing factor of bronchopulmonary dysplasia.

• Effects of volume-targeted synchronized intermittent mandatory ventilation on spontaneous episodes of hypoxemia in preterm infants-Polimeni

  By permission: Polimeni, V. et al: Biol Neonate 2006;89:50-55. Permission granted by S. Karger AG, Basel.
  Hypoxemic episodes in ventilated preterm infants are frequently caused by reduced ventilation due to a decrease in lung volume and acute worsening of respiratory mechanics.

• Volume targeted ventilation-volume guarantee-in the weaning phase of premature newborn infants-Scopesi

  To compare pressure support ventilation combined with volume guarantee (PSV-VG) to synchronized intermittent mandatory ventilation (SIMV) regarding safety, course of blood gases, and infant-ventilator interaction in premature infants.

• Impact of volume guarantee ventilation on arterial carbon dioxide tension in newborn infants-A randomized controlled trial-Cheema IU

  By Permission: EARLY HUMAN DEVELOPMENT, Vol 83, 2006, pp183-189
  To compare the effects of the two modes of ventilation, synchronous intermittent positive pressure ventilation (SIPPV) and SIPPV with Volume Guarantee (VG), on arterial carbon dioxide tension (PaCO2) immediately after neonatal unit admission.

• Performance of neonatal ventilators in volume targeted ventilation mode-Sharma

  To test the hypothesis that in volume targeted ventilation modes, ventilator performance would vary according to ventilator type.

• Volume-targeted modes of modern neonatal ventilators-how stable is the delivered tidal volume-Jaecklin

  Volume-targeted modes are designed to deliver a constant tidal volume (V_T) at lowest possible pressure independently of changes in compliance, resistance, and leak of the respiratory system.

• Neonatal volume guarantee ventilation-effects of spontaneous breathing triggered and untriggered inflations-McCallion

  During volume guarantee (VG) ventilation the peak inflating pressure (PIP) for each ventilator inflation is adjusted to ensure the expired tidal volume (V_Te) is close to the set V_Te. To investigate the effects of triggered and untriggered inflations on PIP and V_Te

• Volume guarantee versus high-frequency ventilation-lung inflammation in preterm infants-Lista-P2009

  Appropriate ventilation together with improvement of clinical care of premature babies can contribute to reducing lung inflammation, known to represent the “primum movens” of bronchopulmonary dysplasia (BPD).

• The impact of instrumental dead-space in volume-targeted ventilation of the extremely low birth weight-ELBW-infant-Nassabeh

  Volume-targeted ventilation is increasingly used in neonatal ventilation to reduce the risk of volutrauma and inadvertent hyperventilation. However, normative data for appropriate tidal volume (V_T) settings are lacking, especially in extremely low birth weight (ELBW) infants in whom the added dead space (DS) of the flow sensor may be important.

• Evolution of tidal volume requirement during the first three weeks of life in extremely low birth weight infants ventilated with volume-targeted ventilation-Keszler

  Volume-targeted ventilation is used in neonates to reduce volutrauma and inadvertent hyperventilation. Little is known about appropriate tidal volume (V_T) settings in extremely low birthweight (ELBW) infants who remain intubated for extended periods.

• Survey of neonatal respiratory support strategies-Sharma

  A questionnaire (in Supplementary Material online) survey of all U.K. neonatal units was undertaken to determine what modes of ventilation, types of endotracheal tube, lung function monitoring and oxygen saturation levels were used.

Non-Invasive Ventilation

Videos and Lectures

• Dr. Null on Neonatal
  Non-Invasive Ventilation
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General

Videos and Lectures

• Dr. Thomas H. Shaffer on
  Liquid Ventilation
  in Neonatal Care
• Dr. Thomas H. Shaffer on
  Other Biomedical Applications
  for Perfluorochemical Liquids in
  Neonatal Care
•  

Research Papers

• Clinical Diagnosis of Pneumothorax Is Late- Use of Trend Data and Decision Support Might Allow Preclinical Detection

  Pneumothorax in the newborn has a significant mortality and morbidity. Early diagnosis would be likely to improve the outlook.

• Kattwinkel Responding to Compliance Changes in a Lung Model During Manual Ventilation

  The standard technique for positive-pressure ventilation is to regulate the breath size by varying the pressure applied to the bag. Investigators have argued that consistency of peak inspiratory pressure is important.

• Reducing Lung Injury during Neonatal Resuscitation of Preterm Infants - Schmoelzer

  Neonatologists are familiar with the concept of ventilator-induced lung injury (VILI) and are increasingly careful in the neonatal intensive care unit (NICU) to apply positive-pressure ventilation (PPV) strategies that are gentle to the lungs.

• Using Back Up Rates During Non-Invasive Ventilation - Manzar

  To evaluate the efficacy of back up rates during non-invasive ventilation (NIV) in premature infants with moderate respiratory distress.

• Ipokrates Seminars

High Frequency Ventilation

Videos and Lectures

• Dr. Null on Neonatal High Frequency Ventilation
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Research Papers

• Lung-protective ventilation strategies in neonatology-What do we know - What do we need to know-Van Kaam Rimensberger

  Randomized controlled trials (RCTs) investigating various lung-protective ventilation modes or strategies in newborn infants have failed to show clear differences in mortality or bronchopulmonary dysplasia.

• High-frequency Ventilation-Evidence-based Practice and Specific Clinical Indications-Keszler

  Chronic lung disease (CLD) remains the leading cause of prolonged hospitalization as well as significant respiratory and developmental handicap in neonates.

• Neonatal High-Frequency Ventilation Past Present and Future-Keszler

  High-frequency ventilation has become established as an effective treatment modality in a variety of clinical situations.

• High-Frequency Ventilation Basics and Practical Application

  In the era of surfactant there are still some neonates who cannot be adequately ventilated with even sophisticated conventional ventilation. Therefore respiratory insufficiency remains one of the major causes of neonatal mortality.

Resuscitation and Stabilization

Videos and Lectures

• Dr. Colin Morley: Infant Resuscitation and Stabilization During the Golden Hour
• Dr. Villani reviews the latest resuscitation and stabilization guidelines (Italian)
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Research Papers

• Using intensive care technology in the Delivery Room - Vento

  Despite dramatic improvements in survival rates of preterm infants over the last 50 years, there have been no significant further improvements in survival or morbidity rates over the most recent 10 years.

• The First Golden Minutes - Vento

  Vento, M. et al: Neonatology 2009;95:286-298. Permission granted by S. Karger AG, Basel.
  An increasing body of evidence has revealed that interventions performed during resuscitation of extremely-low-gestational-age neonates (ELGANs) may have a direct influence on the immediate survival and also on long-term morbidity.

Clinical Guidelines

• Resuscitation Resource Links

Ventilation

• Dr. Null on Conventional
  Neonatal Ventilation
• Dr. Null on Neonatal
  Non-Invasive Ventilation
• Dr. Null on Neonatal High Frequency Ventilation
•  

Research Papers

• Achievement of Targeted Saturation Values in Extremely Low Gestational Age Neonates

  Extremely low gestational age neonates have very low oxygen saturation in utero and an immature antioxidant defense system. Abrupt increases in oxygen saturation after birth may cause oxidative stress.

• Avoiding Hyperoxia in Infants Smaller than 1200g

  To determine the rate and severity of short- and long-term morbidity in very low birth weight infants treated before and after the implementation of a change in clinical practice designed to avoid hyperoxia.

• Advances in Neonatal Resuscitation - Morley/Davis

  Although neonatologists use the term resuscitation we rarely practise resuscitation as the adult doctors understand it.

• Neonatal resuscitation Raising The Bar - Finer/Rich

  To provide an overview of neonatal resuscitation practices with an emphasis on interventions that are not currently accepted or adapted into existing resuscitation guidelines.

• Respiratory Function Monitor Improves Mask Ventilation - Wood/Morley

  This study investigated whether the use of a respiratory monitor during simulated neonatal resuscitation reduced leak at the face mask

• Kattwinkel Responding to Compliance Changes in a Lung Model During Manual Ventilation

  The standard technique for positive-pressure ventilation is to regulate the breath size by varying the pressure applied to the bag. Investigators have argued that consistency of peak inspiratory pressure is important.

• Minimizing Ventilator Induced Lung Injury in Preterm Infants - Donn/Sinha

  Ventilator induced lung injury continues to occur at an unacceptably high rate, which is inversely related to gestational age.

• Reducing Lung Injury during Neonatal Resuscitation of Preterm Infants - Schmoelzer

  Neonatologists are familiar with the concept of ventilator-induced lung injury (VILI) and are increasingly careful in the neonatal intensive care unit (NICU) to apply positive-pressure ventilation (PPV) strategies that are gentle to the lungs. Although PPV also is commonly used in the delivery room (DR), clinicians appear less aware that the same gentle approach should be applied to reduce lung injury during the first few minutes of life.

• Sustainable Use of Continuous Positive Airway Pressure - Booth

  Early use of nasal continuous positive airway pressure (nCPAP) may reduce lung damage, but it is not clear how many extremely preterm infants can be cared for without mechanical ventilation on the first days after delivery.

• To intubate or not- that is the question

  There is currently a great dilemma regarding the early management of extremely low birthweight (ELBW) infants, which involves the use of continuous positive airway pressure (CPAP) after delivery compared with the use of prophylactic or early surfactant.

• Using intensive care technology in the Delivery Room - Vento

  Before the last decade, increased survival rates of preterm infants had been attributed to regionalization of high-risk pregnancies, use of prenatal corticosteroids, and an aggressive approach to perinatal therapy

• The First Golden Minutes - Vento

  Vento, M. et al: Neonatology 2009;95:286-298. Permission granted by S. Karger AG, Basel.
  An increasing body of evidence has revealed that interventions performed during resuscitation of extremely-low-gestational-age neonates (ELGANs) may have a direct influence on the immediate survival and also on long-term morbidity.

• Neonatal Volume Guarantee Ventilation - Morley

  During volume guarantee (VG) ventilation the peak inflating pressure (PIP) for each ventilator inflation is adjusted to ensure the expired tidal volume (V_Te) is close to the set V_Te.

• A Drop in Gas Temperature in the External Part of the Endotracheal Tube - Yamada

  During neonatal respiratory support, maintaining optimal humidity minimizes the risk of airway occlusion and chronic lung disease.

• Predictors of Fatality in Neonates Requiring Mechanical Ventilation - Mathur/Garg/Mishra

  The objective is to evaluate initial arterial blood gas, pulmonary mechanics (compliance and resistance), pulmonary volumes, oxygenation indices and serum carotenoid levels as predictors of fatality in mechanically ventilated neonates.

• CPAP in Delivery Room

  A Unit in Texas was anxious to avoid intubating its preterm babies who had good respiratory effort. Instead its doctors were advocating CPAP in the delivery room and thereafter.