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Mechanical Ventilation Strategies

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Mechanical Ventilation in Neonates and Children

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Abstract

Careful analysis of underlying respiratory pathophysiology is necessary to match ventilator strategies to deliver the intended minute alveolar ventilation in the least injurious fashion. Considerations most crucial in choosing the respiratory support variables are functional residual capacity, time constant and critical opening pressure. Assessment of altered pathophysiology is based on clinical examination, type of disease being treated, blood gas analysis and imaging modalities. All 4 phases of breath; initiation of inspiration, inspiratory flow, termination of inspiration and expiratory phase can be modified to deliver the dose of alveolar ventilation in the safest possible way. In general, diseases with decreased compliance (short time constant) are best managed with smaller tidal volume (VT) and faster rate. Slower rates and larger VT are more suitable for diseases with increased resistance (long time constant). The patient should be periodically assessed for weaning from mechanical ventilation and extubation. Most clinicians prefer either a CPAP or pressure support with PEEP to determine extubation readiness. Mechanical ventilation may cause lung injury through a variety of mechanisms such as mechanotrauma, biotrauma, atelectrauma, barotrauma, volutrauma and infection. Various strategies exist to minimize such injuries. Considerations of heart–lung interactions, both adverse and beneficial, are important management considerations.

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Change history

  • 01 January 2022

    The original version of the book was published with images where the labels and text were misaligned and were inadvertently processed as such for the chapters 1, 2, 3 and 7. The erratum chapter has been updated with the changes.

Suggested Readings

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Author information

Authors and Affiliations

  1. Professor of Pediatrics, Former Pediatrician in Chief and Interim Chairman Children’s Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien, Detroit, MI, 48201, USA

    Ashok P. Sarnaik

  2. Professor, Departments of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Shekhar T. Venkataraman

  3. Medical Director, Respiratory Care Services, Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion 2117, Pittsburgh, PA, 15224, USA

    Shekhar T. Venkataraman

Authors
  1. Ashok P. Sarnaik
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  2. Shekhar T. Venkataraman
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Corresponding author

Correspondence to Ashok P. Sarnaik .

Editor information

Editors and Affiliations

  1. Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA

    Ashok P. Sarnaik

  2. Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA

    Shekhar T. Venkataraman

  3. Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Bradley A. Kuch

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Sarnaik, A.P., Venkataraman, S.T. (2022). Mechanical Ventilation Strategies. In: Sarnaik, A.P., Venkataraman, S.T., Kuch, B.A. (eds) Mechanical Ventilation in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-030-83738-9_7

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  • DOI: https://doi.org/10.1007/978-3-030-83738-9_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-83737-2

  • Online ISBN: 978-3-030-83738-9

  • eBook Packages: MedicineMedicine (R0)

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