Papoff P, Caresta E, Manganaro M, Cicchetti R, Mancuso M, Ferro V, Moretti C
UOC Pediatria d'urgenza e terapia intensiva pediatrica, Policlinico Umberto I, Roma.
Minerva Pediatr. 2010 Jun;62(3 Suppl 1):133-5.
Mechanical ventilation is considered a supportive, nontherapeutic technology used to perform the work of breathing for patients who are unable to do so on their own. In neonatology, mechanical ventilation is often used for premature neonates who are unable to sustain ventilation because of reduced functional residual capacity due to surfactant deficiency. Mechanical ventilation is thus an attempt to mimic the respiratory system's physiological function of gas exchange until the respiratory system reaches maturation. In pediatrics, mechanical ventilation is rarely used for acute respiratory distress syndrome as shown by Dahlem et al. in 2003 who found that only 9.9% of cases of respiratory failure in PICU was caused by ARDS. For this reason, ventilatory techniques in PICU are very heterogenous from the assisted to the most aggressive controlled modes associated with ventilator maneuvers. There are no specific guidelines for the use of mechanical ventilation in children and the low number of infants with ARDS in PICU makes it difficult to run randomized controlled trials in this population. Thus the algorithms are based on the results of either adult or neonatal studies. The advantage of extrapolating data from the neonatal evidence relates mainly to the prevention of ventilator induced lung injury (e.g., CPAP, HFOV, NIV, permissive hypercapnia, surfattant), of which neonatologists are particularly expert.
机械通气被认为是一种支持性而非治疗性的技术，用于为无法自主呼吸的患者进行呼吸工作。在新生儿学中，机械通气常用于因表面活性物质缺乏导致功能残气量减少而无法维持通气的早产儿。因此，机械通气是一种试图模拟呼吸系统气体交换生理功能的手段，直到呼吸系统发育成熟。在儿科学中，如达勒姆等人在2003年所示，机械通气很少用于急性呼吸窘迫综合征，他们发现儿科重症监护病房（PICU）中只有9.9%的呼吸衰竭病例是由急性呼吸窘迫综合征引起的。因此，PICU中的通气技术从辅助模式到与通气操作相关的最激进的控制模式都非常多样化。儿童使用机械通气没有具体指南，且PICU中急性呼吸窘迫综合征婴儿数量较少，使得在该人群中开展随机对照试验很困难。因此，这些算法是基于成人或新生儿研究的结果。从新生儿证据推断数据的优势主要在于预防呼吸机诱发的肺损伤（如持续气道正压通气、高频振荡通气、无创通气、允许性高碳酸血症、表面活性剂），新生儿科医生在这方面尤为专业。
