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Ventilatory support for infants in emergency and in the intensive care unit
S Suresh1, P K Birmingham, T M Ravindranath
1Department of Anesthesia, Northwestern University, Chicago, USA.
Insights
Advances in pediatric anesthesia and intensive care have significantly improved outcomes for newborn surgical emergencies. This review covers airway management, ventilation strategies, and novel treatments like nitric oxide and ECMO.
Area of Science:
- Pediatric Anesthesiology
- Neonatal Intensive Care
- Pediatric Critical Care Medicine
Background:
- Pediatric anesthesia and intensive care have seen significant advancements over the last 20 years.
- Improved understanding of newborn surgical emergencies, new medications, and ventilatory support enhance patient outcomes.
Purpose of the Study:
- To review the anatomy and physiology of the infant airway.
- To discuss indications and principles for endotracheal intubation.
- To cover the management of newborn surgical emergencies and post-operative care.
Main Methods:
- Review of literature on infant airway anatomy and physiology.
- Analysis of endotracheal intubation principles and indications.
- Examination of newborn surgical emergency management strategies.
- Evaluation of post-operative ventilatory support, including mechanical ventilation modes, complications, weaning, and extubation.
- Discussion of nitric oxide and extracorporeal membrane oxygenation (ECMO) for refractory cases.
Main Results:
- Enhanced understanding of infant airway pathophysiology.
- Development of new medications and ventilatory support modes.
- Improved patient outcomes in newborn surgical emergencies.
- Established criteria for mechanical ventilation weaning and extubation.
- Emerging roles for nitric oxide and ECMO in critical neonatal care.
Conclusions:
- Significant progress in pediatric anesthesia and intensive care has improved outcomes for neonates undergoing surgery.
- Comprehensive management strategies, including advanced ventilation and novel therapies, are crucial for complex cases.
- Continued research and application of new technologies like ECMO are vital for refractory neonatal respiratory failure.
Abstract:
Pediatric anesthesia and intensive care management has improved dramatically over the past two decades. Improved understanding of the pathophysiology underlying newborn surgical emergencies, new medications and new modes of ventilatory support have all contributed to better patient outcome. The authors have reviewed the anatomy and physiology of the infant airway, indications for and principles of endotracheal intubation, the management of newborn surgical emergencies, indications for post-operative ventilatory support, different modes of mechanical ventilation available, complications of mechanical ventilation with weaning parameters and extubation criteria. The introduction of nitric oxide and the implications of extracorpreal membrane oxygenation in the management of newborn emergency refractory to conventional ventilation are discussed.