Nonconventional Mechanical Ventilation

Abstract

The success of mechanical ventilation for pediatric respiratory failure has resulted in decreased mortality for the most commonly occurring causes of pediatric lung injury. In addition to the evolution of the capabilities and sophistication of mechanical ventilators used in pediatric critical care medicine, the success with mechanical ventilation has spawned developments in three other distinct areas. First, support for oxygenation and ventilation in ways that are less invasive and less intrusive, not requiring endotracheal intubation, has allowed the critical care practitioner to support children with more comfort and improved safety. Second, rescue forms of support for oxygenation and ventilation that minimize the adverse effects of conventional tidal ventilation, minimizing trauma due to overdistention, have continued to evolve. Finally, survival of children with chronic respiratory compromise, requiring levels of support that can be achieved outside the intensive care unit, has enabled an entire population of long-term ventilator-dependent children to survive in the home setting. Experience in these three areas has grown in the last decades, with arguably demonstrable success but, in most cases, without rigorous study and evaluation of efficacy or superiority. This chapter describes these forms of nonconventional mechanical ventilation, a logical and practical application of their use, and documentation of their value or efficacy where available.