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Over the past three decades, a myriad of new ventilatory modalities have been developed for use in neonatal critical care. Most of these modalities are based on a specific physiological rationale. Supportive evidence is sparse and where it exists mostly comes from studies which are short-term and have a physiological variable as their primary outcome. Randomised controlled trials with clinically important long-term outcomes are rare in this field. In the absence of high quality evidence, the clinical practice of neonatal mechanical respiratory support varies widely between countries, between units and even within units depending on individual preferences.
Bhat et al1 present a cross-over study of Proportional Assist Ventilation (PAV) versus Assist Control Ventilation. Conventional modes of patient-triggered ventilation such as Assist Control typically synchronise a preset ventilator cycle to certain time points of the spontaneous inspiratory effort. For example, the upstroke in ventilator pressure is coupled to the onset of spontaneous inspiration. With all these conventional modes, most clinicians think of the ventilator as a pump. The concept of PAV is fundamentally different; the applied ventilator pressure is continuously coupled to signals derived from the infant’s spontaneous breathing. This …
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