Ventilation for Beginners

The primary objective of assisted ventilation is to support breathing until the infant’s respiratory efforts are sufficient. Ventilation may be required during the immediate care of the depressed or apnoeic infant, or during prolonged periods of treatment of respiratory failure. Improved survival from advances in neonatal care has resulted in an increased number of infants at risk for chronic lung disease.

Newborns are vulnerable to impaired gas exchange due to their high metabolic rate, tendency for decreased functional residual capacity and decreased compliance, increased resistance and potential for right-to-left shunting through the ductus arteriosus and/or foramen ovale. Hypercapnia and hypoxaemia may coexist, although some disorders may affect gas exchange differentially.

Therefore the goals of mechanical ventilation may be summarised as follows:

to achieve and maintain adequate pulmonary gas exchange
to minimise the risk of lung injury
to reduce the work of breathing
to optimise infant comfort

Ventilatory failure is defined as the failure of the lungs to eliminate carbon dioxide.

Oxygenation is the diffusion of oxygen across the alveoli, providing the oxygen necessary for cell resistance. Increases in resistance will significantly increase the work that a patient has to make in order to pull in a breath.

Oxygenation failure is defined as a failure of the heart and lungs to provide adequate oxygen for metabolic needs.

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