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Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective
Extremely preterm infants commonly suffer from respiratory distress syndrome. Ventilatory management of these infants starts from birth and includes decisions such as timing of respiratory support in relation to umbilical cord management, oxygenation targets, and options of positive pressure support...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300007/ https://www.ncbi.nlm.nih.gov/pubmed/34878697 http://dx.doi.org/10.1111/pan.14369 |
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author | Schulzke, Sven M. Stoecklin, Benjamin |
author_facet | Schulzke, Sven M. Stoecklin, Benjamin |
author_sort | Schulzke, Sven M. |
collection | PubMed |
description | Extremely preterm infants commonly suffer from respiratory distress syndrome. Ventilatory management of these infants starts from birth and includes decisions such as timing of respiratory support in relation to umbilical cord management, oxygenation targets, and options of positive pressure support. The approach of early intubation and surfactant administration through an endotracheal tube has been challenged in recent years by primary noninvasive respiratory support and newer methods of surfactant administration via thin catheters. Available data comparing the thin catheter method to endotracheal tube and delayed extubation in extremely preterm infants born before 28 weeks of gestation did not show differences in survival free of bronchopulmonary dysplasia. Data from numerous randomized trials comparing conventional ventilation with high‐frequency oscillatory ventilation did not show differences in meaningful outcomes. Among conventional modes of ventilation, there is good evidence to favor volume‐targeted ventilation over pressure‐limited ventilation. The former reduces the combined risk of bronchopulmonary dysplasia or death and several important secondary outcomes without an increase in adverse events. There are no evidence‐based guidelines to set positive end‐expiratory pressure in ventilated preterm infants. Recent research suggests that the forced oscillation technique may help to find the lowest positive end‐expiratory pressure at which lung recruitment is optimal. Benefits and risks of the various modes of noninvasive ventilation depend on the clinical setting, degree of prematurity, severity of lung disease, and competency of staff in treating associated complications. Respiratory care after discharge includes home oxygen therapy, lung function monitoring, weaning from medication started in the neonatal unit, and treatment of asthma‐like symptoms. |
format | Online Article Text |
id | pubmed-9300007 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93000072022-07-21 Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective Schulzke, Sven M. Stoecklin, Benjamin Paediatr Anaesth Educational Reviews Extremely preterm infants commonly suffer from respiratory distress syndrome. Ventilatory management of these infants starts from birth and includes decisions such as timing of respiratory support in relation to umbilical cord management, oxygenation targets, and options of positive pressure support. The approach of early intubation and surfactant administration through an endotracheal tube has been challenged in recent years by primary noninvasive respiratory support and newer methods of surfactant administration via thin catheters. Available data comparing the thin catheter method to endotracheal tube and delayed extubation in extremely preterm infants born before 28 weeks of gestation did not show differences in survival free of bronchopulmonary dysplasia. Data from numerous randomized trials comparing conventional ventilation with high‐frequency oscillatory ventilation did not show differences in meaningful outcomes. Among conventional modes of ventilation, there is good evidence to favor volume‐targeted ventilation over pressure‐limited ventilation. The former reduces the combined risk of bronchopulmonary dysplasia or death and several important secondary outcomes without an increase in adverse events. There are no evidence‐based guidelines to set positive end‐expiratory pressure in ventilated preterm infants. Recent research suggests that the forced oscillation technique may help to find the lowest positive end‐expiratory pressure at which lung recruitment is optimal. Benefits and risks of the various modes of noninvasive ventilation depend on the clinical setting, degree of prematurity, severity of lung disease, and competency of staff in treating associated complications. Respiratory care after discharge includes home oxygen therapy, lung function monitoring, weaning from medication started in the neonatal unit, and treatment of asthma‐like symptoms. John Wiley and Sons Inc. 2021-12-15 2022-02 /pmc/articles/PMC9300007/ /pubmed/34878697 http://dx.doi.org/10.1111/pan.14369 Text en © 2021 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Educational Reviews Schulzke, Sven M. Stoecklin, Benjamin Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective |
title | Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective |
title_full | Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective |
title_fullStr | Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective |
title_full_unstemmed | Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective |
title_short | Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective |
title_sort | update on ventilatory management of extremely preterm infants—a neonatal intensive care unit perspective |
topic | Educational Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9300007/ https://www.ncbi.nlm.nih.gov/pubmed/34878697 http://dx.doi.org/10.1111/pan.14369 |
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