Newer modes of mechanical ventilation for the neonate

For decades, the overwhelming majority of infants requiring mechanical ventilation for respiratory failure were treated with standard time-cycled, pressure-limited intermittent mandatory ventilation. Technologic advances in the 1990s brought forth sophisticated transducers and microprocessor-based mechanical ventilators that enabled implementation of many newer modes of mechanical ventilation. Some of these are volume-targeted rather than pressure-targeted, and many allow an element of patient control of the ventilator, including initiation and termination of inspiration and control of flow. Some modes are even hybrids, combining the best features of both pressure-targeted and volume-targeted modes. This article reviews the principles and salient clinical features of the newer ventilatory modes for newborns with respiratory failure.