Optimal Strategies of Mechanical Ventilation: Can We Avoid or Reduce Lung Injury?

Area of Science:

• Neonatal respiratory support
• Pediatric critical care
• Pulmonary medicine

Background:

• Invasive mechanical ventilation is often necessary for preterm infants despite non-invasive options.
• Mechanical ventilation poses a risk for ventilator-induced lung injury (VILI), a major factor in bronchopulmonary dysplasia (BPD) development.
• Understanding lung protective ventilation is essential to mitigate BPD risk.

Purpose of the Study:

• To highlight the importance of lung protective ventilation strategies in neonatal mechanical ventilation.
• To discuss the mechanisms of VILI and how to prevent them.
• To review current evidence on effective ventilation strategies for preterm infants.

Main Methods:

• Review of existing literature on neonatal mechanical ventilation and VILI.
• Analysis of risk factors for VILI, including overdistension, atelectasis, and oxygen toxicity.
• Evaluation of the efficacy of volume-targeted ventilation (VTV) and high-frequency ventilation (HFV) in reducing VILI and BPD.

Main Results:

• VILI risk factors necessitate strategies that optimize lung volume, limit tidal volumes, and reduce oxygen exposure.
• Volume-targeted ventilation (VTV) demonstrates effectiveness in stabilizing tidal volumes, reducing VILI, and lowering BPD rates in preterm infants.
• High-frequency ventilation (HFV) shows a modest, though inconsistent, benefit in reducing BPD.

Conclusions:

• A foundational understanding of neonatal lung physiology and VILI is critical for effective mechanical ventilation.
• Current evidence supports VTV and HFV as the primary methods for implementing lung protective ventilation principles.
• Further research may be needed to clarify the benefits of VTV and HFV in infants with heterogeneous lung disease.