Pulmonary Complications of Mechanical Ventilation in Neonates

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Mechanical ventilation is necessary and life saving in many neonates. Most complications are inherent to this intervention and cannot be confused with iatrogenic errors in judgment or care practices by clinicians. Clinical data suggest that complications such as volutrauma and air leak syndromes can negatively affect long-term pulmonary and non-pulmonary outcomes. Careful attention to many aspects of neonatal care, such as delivery room resuscitation, ventilatory support, and routine care practices, is needed to decrease pulmonary complications of mechanical ventilation. Clinical research is needed to improve mechanical ventilator strategies to reduce pulmonary complications and improve long-term outcomes.

Section snippets

Volutrauma

Experimental data demonstrate that mechanical ventilation using both high tidal volumes and high peak pressures can cause lung injury [3], [4], [5], [6]; however, data from various investigators consistently demonstrate that, regardless of the peak pressure, markers of lung injury in animals are increased with high tidal volume ventilation but not with low tidal volume ventilation [7], [8], [9], [10]. Only a few breaths of large tidal volume ventilation immediately after birth can reduce

Air leak syndromes

Complications of mechanical ventilation related to volutrauma include various types of extrapulmonary air leakage, such as pneumothorax and pulmonary interstitial emphysema. Air leak syndromes are important causes of morbidity and mortality in neonates [33], [34]. In fact, Powers and colleagues reported that infants weighing less than 1500 g and diagnosed with pneumothorax during the first 24 hours of life were 13 times more likely to die or have BPD [34]. Pneumothorax is associated with

Tracheal injury and endotracheal tube complications

Subglottic stenosis is a complication that occurs in approximately 1% to 2% of intubated neonates [48], [49]. In one study, the incidence of subglottic stenosis was greater if the ratio of the external diameter of the endotracheal tube divided by the gestational age of the infant in weeks was more than 0.1 [50]. A recent case series described subglottic cysts as an abnormality often seen in conjunction with subglottic stenosis. Subglottic cysts are a recognized complication of intubation in

Summary

Mechanical ventilation is necessary and life saving in many neonates. Most complications are inherent to this intervention and cannot be confused with iatrogenic errors in judgment or care practices by clinicians. Clinical data suggest that complications such as volutrauma and air leak syndromes can negatively affect long-term pulmonary and non-pulmonary outcomes. One specific intervention or strategy is unlikely to decrease complications of mechanical ventilation. Careful attention to many

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