Lung-protective ventilation in neonatology

Area of Science:

• Neonatology
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Ventilator-induced lung injury (VILI) is a significant risk factor for bronchopulmonary dysplasia (BPD) in neonates.
• VILI is caused by lung overdistension (volutrauma) and repetitive alveolar collapse (atelectrauma).
• Lung-protective ventilation aims to minimize VILI through reduced tidal volumes and open lung strategies.

Purpose of the Study:

• To review the current evidence on lung-protective ventilation strategies in neonatology.
• To compare high-frequency ventilation (HFV) and positive pressure ventilation (PPV) for VILI prevention.
• To identify gaps in knowledge regarding optimal ventilator settings and modes.

Main Methods:

• Systematic review of existing literature on lung-protective ventilation in neonates.
• Analysis of studies comparing HFV and PPV.
• Evaluation of evidence on tidal volume, positive end-expiratory pressure (PEEP), and lung recruitment.

Main Results:

• HFV did not demonstrate a clear benefit over PPV in preventing VILI.
• Many studies failed to implement a true open lung ventilation strategy during HFV.
• Limited evidence exists on optimal tidal volume, PEEP, and lung recruitment for lung-protective PPV.
• Volume-targeted ventilation shows promise but requires further investigation.

Conclusions:

• Current evidence does not strongly support HFV over PPV for lung protection in neonates.
• Optimal lung-protective ventilation parameters and strategies require further research.
• The slow adoption of lung-protective ventilation modes in clinical practice highlights the need for more robust evidence.