Assisted ventilation: a critical review.

Assisted ventilation is a complex technique that has been responsible for much of the improvement in neonatal morbidity and mortality during the last 10 to 15 years. In unskilled hands, however, it can be dangerous. Complications run as high as 30% in some series. Assisted ventilation requires a constantly available medical and nursing team that can supervise the care of a critically ill infant around the clock. It cannot be done from a remote office, but must be carried out by intensivists on the spot. A large investment in time, labor, and skill is needed to reap the benefits without paying an excessive price in terms of morbidity among surviving infants. While the community-based pediatrician must become expert at recognizing the signs of neonatal respiratory distress and initiating the first steps to diagnose and stabilize sick infants, it is not to be expected that the definitive care of such infants can take place in every locality. Therefore local hospitals must recognize their limitations of staff and financial commitment to the care of these infants and form close clinical and educational links with tertiary hospitals capable of long-term care of infants with respiratory distress who require assisted ventilation.