Modern mechanical ventilation strategies in newborns: a review

Noninvasive ventilation is increasingly used in newborns, but intubation and mechanical ventilation remain important lifesaving tools for neonatal intensive care. New lung-protective mechanical ventilation technologies were developed in the last few decades and are now commercially available. Nevertheless, a recent survey (van Kaam et al. J Pediatr 2010) reported that time-cycled pressure-limited ventilation is the most common mode in neonatal ventilation and that newer ventilation modes are rarely used. The aim of this survey was to provide an overview of modern ventilation strategies based on available clinical studies. These new ventilation strategies can improve numerous physiological variables, but there is little information about the associated risks and long-term outcomes. We suggest that additional randomized controlled trials of these new ventilation strategies are needed before any definitive recommendations can be given.