Kumar Jogender, Kumar Praveen, Bhandari Vineet
Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Neonatal Unit, Chandigarh, 160012, India.
Division of Neonatology, Department of Pediatrics, Cooper Medical School of Rowan University, The Children's Regional Hospital at Cooper, Camden, NJ, 08103, USA.
Indian Pediatr. 2025 Jun 3. doi: 10.1007/s13312-025-00094-6.
We provide evidence-based recommendations and clinical guidance on strategies for invasive mechanical ventilation in neonates until successful extubation in the neonatal intensive care unit. A systematic search of the PubMed, Embase, and CENTRAL databases was performed to identify relevant published literature from the past five years. A critical review of the current literature was conducted to provide context-specific recommendations. We discuss the various modes of invasive mechanical ventilation in neonates, with specific recommendations for neonates with persistent pulmonary hypertension, congenital heart disease, congenital diaphragmatic hernia, pneumonia, meconium aspiration syndrome, air leak syndromes, evolving and established bronchopulmonary dysplasia, apnea, and very preterm infants with respiratory distress. Practical guidance for the initiation, titration, and weaning of volume-targeted ventilation is also provided. Synchronized patient-triggered modes (synchronized intermittent mandatory ventilation + pressure support ventilation/assist control ventilation) and volume-target/guarantee modes are the preferred modes of invasive mechanical ventilation in neonates with respiratory distress.
我们针对新生儿重症监护病房中新生儿有创机械通气直至成功拔管的策略提供基于证据的建议和临床指导。对PubMed、Embase和CENTRAL数据库进行了系统检索，以识别过去五年发表的相关文献。对当前文献进行了批判性综述，以提供针对具体情况的建议。我们讨论了新生儿有创机械通气的各种模式，并针对患有持续性肺动脉高压、先天性心脏病、先天性膈疝、肺炎、胎粪吸入综合征、气漏综合征、进展期和已确诊的支气管肺发育不良、呼吸暂停以及患有呼吸窘迫的极早产儿的新生儿给出了具体建议。还提供了容量目标通气启动、滴定和撤机的实用指导。同步患者触发模式（同步间歇指令通气+压力支持通气/辅助控制通气）和容量目标/保障模式是患有呼吸窘迫的新生儿有创机械通气的首选模式。
