Invasive Ventilation Strategies in Neonates

We provide evidence-based recommendations and clinical guidance on strategies for invasive mechanical ventilation in neonates until successful extubation in the neonatal intensive care unit. A systematic search of the PubMed, Embase, and CENTRAL databases was performed to identify relevant published literature from the past five years. A critical review of the current literature was conducted to provide context-specific recommendations. We discuss the various modes of invasive mechanical ventilation in neonates, with specific recommendations for neonates with persistent pulmonary hypertension, congenital heart disease, congenital diaphragmatic hernia, pneumonia, meconium aspiration syndrome, air leak syndromes, evolving and established bronchopulmonary dysplasia, apnea, and very preterm infants with respiratory distress. Practical guidance for the initiation, titration, and weaning of volume-targeted ventilation is also provided. Synchronized patient-triggered modes (synchronized intermittent mandatory ventilation + pressure support ventilation/assist control ventilation) and volume-target/guarantee modes are the preferred modes of invasive mechanical ventilation in neonates with respiratory distress.