Respiratory support using patient triggered ventilation in the neonatal period

There are now a number of purpose built patient triggered ventilators for use in the newborn. These ventilators are triggered either by air flow or airway pressure changes, their triggering devices all have very high sensitivity and short systems delay. They all have the advantage that they perform well without inadvertent positive end expiratory pressure at the fast ventilator rates frequently triggered by immature infants. Despite all these improvements in both ventilator and trigger performance, PTV is still frequently unsuccessful in the most immature infants. We must conclude that the nature of the extremely preterm infant's respiratory efforts in the acute stage of respiratory illness may mean that PTV is unlikely to provide the optimal mode of respiratory support for this group of patients. Short term studies have suggested that those infants with relatively mild respiratory distress syndrome showed the greatest improvement in blood gases. These results suggest that PTV may have its most efficacious role during weaning and in the larger, more mature baby who is 'fighting the ventilator'.