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Neonatal ventilators: how do they differ?

Journal of Perinatology volume 29, pages S73–S78 (2009)Cite this article

Abstract

Remarkable technological advances over the past two decades have brought dramatic changes to the neonatal intensive care unit. Microprocessor-based mechanical ventilation has replaced time-cycled, pressure-limited, intermittent mandatory ventilation with almost limitless options for the management of respiratory failure in the prematurely born infant. Unfortunately, much of the infusion of technology occurred before the establishment of a convincing evidence base. This review focuses on the basic principles of mechanical ventilation, nomenclature and the characteristics of both conventional and high-frequency devices.

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References

  1. Delivoria-Papadopoulos M, Levison H, Swyer P . Intermittent positive pressure respiration as a treatment in severe respiratory distress syndrome. Arch Dis Child 1965; 40: 474–478.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bunnell JB . High frequency ventilation: general concepts. In: Donn SM, Sinha SK (eds). Manual of Neonatal Respiratory Care, 2nd edn. Mosby Elsevier: Philadelphia, 2006, pp 222–230.

    Google Scholar 

  3. Sinha SK, Donn SM . Newer forms of conventional ventilation for preterm newborns. Acta Paediatr 2008; 97: 1338–1343.

    Article  PubMed  Google Scholar 

  4. Becker MA, Donn SM . Real-time pulmonary graphic monitoring. Clin Perinatol 2007; 34: 1–17.

    Article  PubMed  Google Scholar 

  5. Hagus CK, Donn SM . Pulmonary graphics: basics of clinical application. In: Donn SM (ed). Neonatal and Pediatric Pulmonary Graphics. Principles and Clinical Applications. Futura Publishing Co.: Armonk, NY, 1998, pp 81–127.

    Google Scholar 

  6. Sarkar S, Donn SM . In support of pressure support. Clin Perinatol 2007; 34: 117–128.

    Article  PubMed  Google Scholar 

  7. Donn SM, Nicks JJ, Becker MA . Flow-synchronized ventilation of preterm infants with respiratory distress syndrome. J Perinatol 1994; 14: 90–94.

    CAS  PubMed  Google Scholar 

  8. Perlman JM, McMenanim JB, Volpe JJ . Fluctuating cerebral blood flow velocity in respiratory distress syndrome: relationship to subsequent development of intraventricular hemorrhage. N Engl J Med 1983; 309: 204–209.

    Article  CAS  PubMed  Google Scholar 

  9. Sinha SK, Donn SM . Pressure support ventilation. In: Donn SM, Sinha SK (eds). Manual of Neonatal Respiratory Care, 2nd edn. Mosby Elsevier: Philadelphia, 2006, pp 212–215.

    Chapter  Google Scholar 

  10. Servant GM, Nicks JJ, Donn SM, Bandy KP, Lathrop C . Feasibility of applying flow-synchronized ventilation to very low birthweight infants. Respir Care 1992; 37: 249–253.

    Google Scholar 

  11. Donn SM . Pressure control ventilation. In: Donn SM, Sinha SK (eds). Manual of Neonatal Respiratory Care, 2nd edn. Mosby Elsevier: Philadelphia, 2006, pp 210–211.

    Chapter  Google Scholar 

  12. Sinha SK, Donn SM . Volume-controlled ventilation. In: Goldsmith JP, Karotkin EH (eds). Assisted Ventilation of the Neonate, 4th edn. WB Saunders: Philadelphia, 2003, pp 171–183.

    Chapter  Google Scholar 

  13. Cannon ML, Cornell J, Tripp-Hamel DS, Gentile MA, Hubble CL, Meliones JN et al. Tidal volumes for ventilated infants should be determined with a pneumotachometer placed at the endotracheal tube. Am J Respir Crit Care Med 2000; 162: 2109–2112.

    Article  CAS  PubMed  Google Scholar 

  14. Dimitriou G, Greenough A, Cherian S . Comparison of airway pressure and air flow triggering systems using a single type of neonatal ventilator. Acta Paediatr 2001; 90: 445–447.

    Article  CAS  PubMed  Google Scholar 

  15. Greenough A, Milner AD, Dimitriou G . Synchronized ventilation. Cochrane Database Syst Rev 2005; Supplement 3, Art No. CD000456.

  16. Baumer JH . International randomized controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 2000; 82: F5–F10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chan V, Greenough A . Randomized controlled trial of weaning by patient triggered ventilation or conventional ventilation. Eur J Pediatr 1993; 152: 51–54.

    Article  CAS  PubMed  Google Scholar 

  18. Chan V, Greenough A . Comparison of weaning by patient triggered ventilation or synchronous intermittent mandatory ventilation in preterm infants. Acta Paediatr 1994; 83: 335–337.

    Article  CAS  PubMed  Google Scholar 

  19. Dimitriou G, Greenough A, Giffin F . Synchronous intermittent mandatory ventilation modes compared with patient triggered ventilation during weaning. Arch Dis Child Fetal Neonatal Ed 1995; 72: F188–F190.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bernstein G, Mannino FL, Heldt GP, Callahan JD, Bull DH, Sola A et al. Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates. J Pediatr 1996; 128: 453–463.

    Article  CAS  PubMed  Google Scholar 

  21. Roze JC, Liet JM, Gournay V, Debillon T, Gaultier C . Oxygen cost of breathing and weaning process in newborn infants. Eur Respir J 1997; 10: 2583–2585.

    Article  CAS  PubMed  Google Scholar 

  22. Dimitriou G, Greenough A, Laubscher B, Yamaguchi N . Comparison of airway pressure-triggered and airflow-triggered ventilation in very immature infants. Acta Paediatr 1998; 87: 1256–1260.

    Article  CAS  PubMed  Google Scholar 

  23. Sinha SK, Donn SM, Gavey J, McCarty M . Randomised trial of volume controlled versus time cycled, pressure limited ventilation in preterm infants with respiratory distress syndrome. Arch Dis Child Fetal Neonatal Ed 1998; 79: F202–F205.

    Article  Google Scholar 

  24. Lista G, Castoldi F, Bianchi S, Battaglioli M, Cavigioli F, Bosoni MA . Volume guarantee versus high-frequency ventilation: lung inflammation in preterm infants. Arch Dis Child Fetal Neonatal Ed 2008; 93: F252–F256.

    Article  CAS  PubMed  Google Scholar 

  25. Singh J, Sinha SK, Clarke P, Byrne S, Donn SM . Mechanical ventilation of very low birth weight infants: is volume or pressure a better target variable? J Pediatr 2006; 149: 308–313.

    Article  PubMed  Google Scholar 

  26. Singh J, Alsop E, Gupta S, Sinha SK, Donn SM . Volume-controlled versus pressure-limited ventilation in very low birth weight infants: long term follow-up of a RCT. Pediatr Acad Soc 2007, Abstract number 752140.

  27. Reyes ZC, Claure N, Tauscher MK, D'Ugard C, Vanbuskirk S, Bancalari E . Randomized, controlled trial comparing synchronized intermittent mandatory ventilation and synchronized intermittent mandatory ventilation plus pressure support in preterm infants. Pediatrics 2006; 118: 1409–1417.

    Article  PubMed  Google Scholar 

  28. Gupta S, Sinha SK, Donn SM . The effect of two levels of pressure support ventilation on tidal volume delivery and minute ventilation in preterm infants. Arch Dis Child 2009; 94: F80–F83.

    Article  CAS  Google Scholar 

  29. Lampland AL, Mammel MC . The role of high-frequency ventilation in neonates: evidenced-based recommendations. Clin Perinatol 2007; 34: 129–144.

    Article  PubMed  Google Scholar 

  30. Keszler M, Donn SM, Bucciarelli RL, Alverson DC, Hart M, Lunyong V et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991; 119: 85–93.

    Article  CAS  PubMed  Google Scholar 

  31. Keszler M, Modanlou HD, Brudno DS, Clark FI, Cohen RS, Ryan RM et al. Multicenter controlled clinical trial of high-frequency jet ventilation in preterm infants with uncomplicated respiratory distress syndrome. Pediatrics 1997; 100: 593–599.

    Article  CAS  PubMed  Google Scholar 

  32. Friedlich P, Subramanian N, Sebald M, Noori S, Seri I . Use of high-frequency jet ventilation in neonates with hypoxemia refractory to high-frequency oscillatory ventilation. J Mat Fetal Neonatal Med 2003; 13: 398–402.

    Article  CAS  Google Scholar 

  33. Gerstmann DR, Minton SD, Stoddard RA, Meredith KS, Monaco F, Bertrand JM et al. The Provo multicenter early high-frequency oscillatory ventilation trial: improved pulmonary and clinical outcome in respiratory distress syndrome. Pediatrics 1996; 98: 1044–1057.

    CAS  PubMed  Google Scholar 

  34. Clark RH, Yoder BA, Sell MS . Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr 1994; 124: 447–454.

    Article  CAS  PubMed  Google Scholar 

  35. Engle WA, Yoder MC, Andreoli SP, Darragh RK, Langefeld CD, Hui SL . Controlled prospective randomized comparison of high-frequency jet ventilation and conventional ventilation in neonates with respiratory failure and persistent pulmonary hypertension. J Perinatol 1997; 17: 3–9.

    CAS  PubMed  Google Scholar 

  36. Moriette G, Paris-Llado J, Walti H, Escande B, Magny JF, Cambone G et al. Prospective randomized multicenter comparison of high-frequency oscillatory ventilation and conventional ventilation in preterm infants of less than 30 weeks with respiratory distress syndrome. Pediatrics 2001; 107: 363–372.

    Article  CAS  PubMed  Google Scholar 

  37. Courtney SE, Durand DJ, Asselin JM, Hudak ML, Aschner JL, Shoemaker CT et al. High-frequency oscillatory ventilation versus conventional mechanical ventilation for very-low-birth-weight infants. N Engl J Med 2002; 347: 643–652.

    Article  PubMed  Google Scholar 

  38. Johnson AH, Peacock JL, Greenough A, Marlow N, Limb ES, Marston L et al. High-frequency oscillatory ventilation for the prevention of respiratory distress syndrome of prematurity. N Engl J Med 2002; 347: 633–642.

    Article  PubMed  Google Scholar 

  39. Bhuta D, Henderson-Smart DJ . Rescue high-frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev 1998; Supplement 2, Art No. CD000438.

  40. Claure N, Gerhardt T, Everett R, Musante G, Herrera C, Bancalari E . Closed-loop controlled inspired oxygen concentration for mechanically ventilated very low birth weight infants with frequent episodes of hypoxemia. Pediatrics 2001; 107: 1120–1124.

    Article  CAS  PubMed  Google Scholar 

  41. Schulze A, Rieger-Fackeldey E, Gerhardt T, Claure N, Everett R, Bancalari E . Randomized crossover comparison of proportional assist ventilation and patient-triggered ventilation in extremely low birth weight infants with evolving chronic lung disease. Neonatology 2007; 92: 1–7.

    Article  CAS  PubMed  Google Scholar 

  42. Guthrie SO, Lynn C, Lafleur BJ, Donn SM, Walsh WF . A crossover analysis of mandatory minute ventilation compared to synchronized intermittent mandatory ventilation in neonates. J Perinatol 2005; 25: 643–646.

    Article  PubMed  Google Scholar 

  43. Amato MB, Barbas CS, Bonassa J, Saldiva PH, Zin WA, de Carvalho CR . Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure. Chest 1992; 102: 1225–1234.

    Article  CAS  PubMed  Google Scholar 

  44. Arnal JM, Wysocki M, Nafati C, Donati S, Granier I, Corno G et al. Automatic selection of breathing pattern using adaptive support ventilation. Intensive Care Med 2008; 34: 75–81.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatal-Perinatal Medicine, CS Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA

    S M Donn

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  1. S M Donn
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Correspondence to S M Donn.

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Donn, S. Neonatal ventilators: how do they differ?. J Perinatol 29 (Suppl 2), S73–S78 (2009). https://doi.org/10.1038/jp.2009.23

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