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Ventilation and Ventilatory Modes in Neonates

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Clinical Anesthesia for the Newborn and the Neonate

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Abstract

Neonatal ventilation is an integral component of advanced neonatal support. Understanding the complex and distinct neonatal physiology is essential for the health professionals involved in care of the extremely premature or critically sick neonates to implement the best practice based on evidence. Given the range of existing and newer modes of ventilation available, clinical decision-making is vitally important in a wider perspective of neonatal care. The core aim of ventilation strategy is to provide respiratory interventions during a compromise to maximize survival while limiting adverse effects. Neonates are at a high risk for respiratory complications during anaesthesia and surgery because of their characteristic respiratory physiology of a delicate balance between the closing volume and functional residual capacity (FRC) and still on-going adaptation adjustments to the extra uterine environment.

Mechanical ventilation (MV) is not without its long term consequences and is considered as a primary risk factor for developing bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), reopening of intracardiac shunts, persistence of fetal circulation and pulmonary hypertension (PHT). Hence babies with an acceptable spontaneous respiratory efforts are now encouraged for non-invasive respiratory support. A ventilatory strategy of low tidal volume with optimum PEEP, and avoidance of excessive O2 administration, may be warranted in parenchymal lung disease. Mild permissive hypercapnia provides modest clinical benefits in selected situations and it is important to avoid large fluctuations in arterial carbon dioxide (PaCO2) levels. Decreasing the duration of MV and early weaning may be important for minimizing pulmonary damage, neurodevelopmental disability and high morbidity and mortality associated with prolonged MV.

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  1. Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

    Deepanjali Pant & Jayashree Sood

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  1. Dept of Anesthesiology, Critical Care Pain and Palliative Care, Lady Hardinge Medical College Smt Sucheta Kriplani and Kalawati Saran Childrens Hospitals, New Delhi, India

    Usha Saha

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Pant, D., Sood, J. (2023). Ventilation and Ventilatory Modes in Neonates. In: Saha, U. (eds) Clinical Anesthesia for the Newborn and the Neonate. Springer, Singapore. https://doi.org/10.1007/978-981-19-5458-0_14

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