Respiratory support techniques for prematurely born infants: new advances and perspectives

A variety of respiratory techniques have been introduced into the neonatal intensive care unit. High frequency positive pressure ventilation (HFPPV) compared to slow rate ventilation significantly reduced the incidence of airleaks, but this has yet to be confirmed in infants routinely exposed to antenatal steroids and postnatal surfactant. Continuous positive airways pressure (CPAP) is useful for infants with obstructive or mixed apnoea and reduces the need for extra respiratory support following extubation, whether it reduces chronic lung disease (CLD) remains to be appropriately tested. Randomised trials have failed to identify long term benefits of patient triggered ventilation (PTV) in infants with acute respiratory distress; but it is the most efficacious mode of weaning. High volume strategy, high frequency oscillation (HFO), if commenced within 24 hours of birth, lowers the CLD rate, but may increase airleak and intracranial pathology. Nitric oxide (NO) can improve oxygenation in preterm infants with suspected pulmonary hypertension, but does not appear to influence outcome. Liquid ventilation is a promising, but relatively untested technique in preterm infants. Ventilator techniques have not been rigorously examined in infants developing or with established CLD. It is essential that the relative merits of new respiratory support techniques are compared in well designed studies which include infants with acute and chronic respiratory distress, only then can their appropriate roles in the management of prematurely born infants be identified.