Neonatal non-invasive respiratory support: physiological implications.
The introduction of assisted ventilation for neonatal pulmonary insufficiency has resulted in the successful treatment of many previously fatal diseases. During the past three decades, refinement of invasive mechanical ventilation techniques has dramatically improved survival of many high-risk neonates. However, as with many advances in medicine, while mortality has been reduced, morbidity has increased in the surviving high-risk neonate. In this regard, introduction of assisted ventilation has been associated with chronic lung injury, also known as bronchopulmonary dysplasia. This disease, unknown prior to the appearance of mechanical ventilation, has produced a population of patients characterized by ventilator or oxygen dependence with serious accompanying pulmonary and neurodevelopmental morbidity. The purpose of this article is to review non-invasive respiratory support methodologies to address the physiologic mechanisms by which these methods may prevent the pathophysiologic effects of invasive mechanical ventilation.
Nemours Center for Pediatric Lung Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA. tshaffer@nemours.org
Thomas H
TH
Shaffer
Deepthi
D
Alapati
Jay S
JS
Greenspan
Marla R
MR
Wolfson
D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000627:therapeutic use; D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure / Q000379:methods; D004338:Drug Combinations; D005233:Fatty Alcohols / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009569:Nitric Oxide / Q000627:therapeutic use; D063087:Noninvasive Ventilation / Q000379:methods*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D010715:Phosphatidylglycerols / Q000627:therapeutic use; D011506:Proteins / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000628:therapy*
D001993:Bronchodilator Agents; D004338:Drug Combinations; D005233:Fatty Alcohols; D010715:Phosphatidylglycerols; D011506:Proteins; D011663:Pulmonary Surfactants; C502722:lucinactant; D009569:Nitric Oxide