Injury and inflammation from resuscitation of the preterm infant.
We review information about how the preterm lung can be injured with the initiation of mechanical ventilation at birth. Although multiple variables such as pressure, tidal volume, positive end expiratory pressure, and the gas used for ventilation may contribute to the injury, the relative contribution of each is not known. Recent studies demonstrate that injury caused by initial high tidal volume is amplified by subsequent mechanical ventilation. A model for gas inflation of the fluid-filled lung may explain why even low tidal volumes may injure the preterm lung, and why the injury may initially occur to the small airways. Ventilation strategies that minimize injury need to be developed.
Jobe
Alan H
AH
Division of Pulmonary Biology, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA. alan.jobe@chmcc.org
Hillman
Noah
N
Polglase
Graeme
G
Kramer
Boris W
BW
Kallapur
Suhas
S
Pillow
Jane
J
D001238:Asphyxia Neonatorum / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008170:Lung Compliance; D055370:Lung Injury / Q000209:etiology* / Q000473:pathology; D011014:Pneumonia / Q000209:etiology* / Q000473:pathology; D011175:Positive-Pressure Respiration; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000009:adverse effects; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods; D013990:Tidal Volume
D011663:Pulmonary Surfactants