Ventilation-Induced Lung Injury (VILI) in Neonates: Evidence-Based Concepts and Lung-Protective Strategies

Area of Science:

• Neonatal Medicine
• Respiratory Physiology
• Pediatric Critical Care

Background:

• Mechanical ventilation is crucial for neonatal respiratory failure but can induce or worsen lung injury.
• Ventilator-induced lung injury (VILI) is a complex condition with multifactorial causes, significantly increasing the risk of bronchopulmonary dysplasia (BPD).
• Bronchopulmonary dysplasia (BPD) is a common chronic respiratory morbidity in preterm infants, lacking targeted therapies and causing long-term health issues.

Purpose of the Study:

• To review preclinical and clinical evidence on the pathogenesis and pathophysiology of VILI in neonates.
• To highlight evidence-based lung-protective strategies for preventing and mitigating VILI and BPD.
• To provide insights into future research directions for minimizing neonatal VILI.

Main Methods:

• Review of preclinical and clinical studies on VILI in neonates.
• Analysis of the multifactorial pathogenesis of VILI, considering ventilator- and patient-related factors.
• Examination of existing and emerging lung-protective ventilation strategies.

Main Results:

• VILI is a significant risk factor for BPD, a chronic respiratory condition in preterm infants.
• Understanding VILI pathogenesis is essential for developing effective mitigation strategies.
• Lung-protective strategies aim to reduce VILI and its long-term consequences, including BPD.

Conclusions:

• Effective management of neonatal respiratory failure requires careful consideration of VILI risks.
• Implementing lung-protective ventilation strategies is critical for attenuating VILI and preventing BPD.
• Continued research into VILI pathogenesis and novel therapeutic approaches is necessary to improve outcomes for neonates.