Department of Neonatology, Emma Children's Hospital Amsterdam UMC, Amsterdam, The Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Neonatology. 2024;121(5):570-575. doi: 10.1159/000539346. Epub 2024 Jun 13.
Despite the increasing use of non-invasive support modalities, many preterm infants still need invasive mechanical ventilation. Mechanical ventilation can lead to so-called ventilator-induced lung injury, which is considered an important risk factor in the development of bronchopulmonary dysplasia. Understanding the concepts of lung protective ventilation strategies is imperative to reduce the risk of BPD.
Overdistension, atelectasis, and oxygen toxicity are the most important risk factors for VILI. A lung protective ventilation strategy should therefore optimize lung volume (resolve atelectasis), limit tidal volumes, and reduce oxygen exposure. Executing such a lung protective ventilation strategy requires basic knowledge on neonatal lung physiology. Studies have shown that volume-targeted ventilation (VTV) stabilizes tidal volume delivery, reduces VILI, and reduces BPD in preterm infants with respiratory distress syndrome. High-frequency ventilation (HFV) also reduces BPD although the effect is modest and inconsistent. It is unclear if these benefits also apply to infants with more heterogeneous lung disease.
Understanding basic physiology and the concept of ventilator-induced lung injury is essential in neonatal mechanical ventilation. Current evidence suggests that the principles of lung protective ventilation are best captured by VTV and HFV.
尽管越来越多地使用非侵入性支持方式，但许多早产儿仍需要进行有创机械通气。机械通气可导致所谓的呼吸机相关性肺损伤，这被认为是支气管肺发育不良发展的一个重要危险因素。了解肺保护性通气策略的概念对于降低 BPD 的风险至关重要。
过度膨胀、肺不张和氧毒性是导致呼吸机相关性肺损伤的最重要危险因素。因此，肺保护性通气策略应优化肺容积（解决肺不张）、限制潮气量并减少氧暴露。执行这种肺保护性通气策略需要对新生儿肺生理学有基本的了解。研究表明，容量目标通气（VTV）可稳定潮气量输送，减少呼吸机相关性肺损伤，并降低呼吸窘迫综合征早产儿的 BPD 发生率。高频通气（HFV）也可降低 BPD，尽管效果适度且不一致。目前尚不清楚这些益处是否也适用于患有更具异质性肺部疾病的婴儿。
理解基本生理学和呼吸机相关性肺损伤的概念对于新生儿机械通气至关重要。目前的证据表明，肺保护性通气的原则最好通过 VTV 和 HFV 来实现。
