Hummler Helmut, Schulze Andreas
Division of Neonatology and Pediatric Critical Care, Children's Hospital, University of Ulm, 89070 Ulm, Germany.
Semin Fetal Neonatal Med. 2009 Feb;14(1):42-8. doi: 10.1016/j.siny.2008.08.006. Epub 2008 Oct 23.
Innovative ventilation modes for infants attempt to reduce volume-induced lung damage, to decrease airway pressure and oxygen exposure, and to improve patient comfort. Volume-targeted ventilation results in more consistent tidal volumes, allows automatic weaning of airway pressure, may avoid hypocapnia and may be associated with long-term clinical benefits. Pressure support ventilation allows the patient to control the duration of mechanical breaths. It requires a stable respiratory drive or back-up for apnoea. Pressure support ventilation may be effective for weaning. Proportional assist ventilation was studied in small animal species. In preterm infants with acute and chronic lung disease, ventilator pressure requirements were lower in cross-over short-term comparisons with conventional triggered ventilation. Neurally adjusted ventilatory assist delivers ventilator pressure in proportion and in synchrony with the phasic inspiratory diaphragmatic electrical activity obtained from intra-oesophageal electrodes. Large multicentre clinical trials are required to prove long-term clinical benefits of these new modes.
针对婴儿的创新通气模式旨在减少容量性肺损伤，降低气道压力和氧气暴露，并提高患者舒适度。容量目标通气可使潮气量更稳定，能自动降低气道压力，可避免低碳酸血症，且可能带来长期临床益处。压力支持通气使患者能够控制机械通气的时长。它需要稳定的呼吸驱动或用于呼吸暂停的后备支持。压力支持通气可能对撤机有效。比例辅助通气已在小型动物物种中进行研究。在患有急性和慢性肺病的早产儿中，与传统触发通气进行交叉短期比较时，其呼吸机压力需求较低。神经调节通气辅助根据从食管内电极获取的阶段性吸气膈肌电活动按比例并同步输送呼吸机压力。需要大型多中心临床试验来证明这些新模式的长期临床益处。
