INSURE, Infant Flow, Positive Pressure and Volume Guarantee--tell us what is best: selection of respiratory support modalities in the NICU.
Selecting the optimal mode of respiratory support remains a daily challenge for the practicing neonatologist. We are faced with a bewildering array of modalities and a paucity of definitive studies to guide our decisions. In this context the choice of therapies must be guided by evidence-based guidelines, supplemented by a solid understanding of the pathophysiology of lung injury, an appreciation of the individual patient's specific disease process/physiologic derangement. The sequential application of the least invasive treatment to achieve the relevant therapeutic goal with frequent re-evaluation of the patient's need and possible escalation of support as needed, coupled with the application of lung-protective strategies of respiratory support appears to offer the best chance of minimizing adverse pulmonary and neurodevelopmental outcomes.
Georgetown University, Washington, DC, USA. keszlerm@gunet.georgetown.edu
Martin
M
Keszler
D002986:Clinical Trials as Topic; D045422:Continuous Positive Airway Pressure; D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007440:Intubation / Q000009:adverse effects; D011663:Pulmonary Surfactants / Q000009:adverse effects / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects; D012129:Respiratory Function Tests; D012138:Respiratory Therapy / Q000009:adverse effects / Q000379:methods*
D011663:Pulmonary Surfactants