[New trends in mechanical ventilation]

Many ventilatory techniques are employed on the Neonatal Intensive Care Unit, but there is limited evidence supporting the use, in particular of the more recently introduced modes. Randomized trials have demonstrated that high frequency positive pressure ventilation reduced airleaks and patient triggered ventilation was associated with a shorter duration of ventilation. "Rescue" high frequency oscillation was suggested to reduce airleaks and prophylactic high frequency oscillation decrease chronic lung disease, but possibly at the expense of increased intracerebral pathology. Results from anecdotal series suggest that nasal continuous positive airways pressure, volume guarantee and pressure support ventilation have advantages, but the techniques have not been subjected to rigorous testing in large randomized trials. Neonatologists must not be seduced by promising preliminary results. Ventilatory strategies should only be introduced into routine clinical practice if proven efficacious and without long term adverse effects in appropriately sized studies.