title: Invasive and non-invasive ventilation for prematurely born infants - current practice in neonatal ventilation.
abstract: Non-invasive techniques, include nasal continuous positive airways pressure (nCPAP), nasal intermittent positive pressure ventilation (NIPPV) and heated, humidified, high flow cannula (HHFNC). Randomised controlled trials (RCTs) of nCPAP versus ventilation have given mixed results, but one demonstrated fewer respiratory problems during infancy. Meta-analysis demonstrated NIPPV rather than nCPAP provided better support post extubation. After extubation or initial support HHFNC has similar efficacy to CPAP. Invasive techniques include those that synchronise inflations with the patient's respiratory efforts. Assist control/ synchronised intermittent mandatory ventilation compared to non triggered modes only reduce the duration of ventilation. Further data are required to determine the efficacy of proportional assist ventilation and neurally adjusted ventilatory assist. Other techniques aim to minimise volutrauma. RCTs of volume targeted ventilation demonstrated reductions in BPD and respiratory medication usage at follow-up. Prophylactic high frequency oscillatory ventilation does not reduce BPD, but is associated with superior lung function at school age.
authors.affiliation: a Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic, Mechanisms of Asthma , King's College London , London , UK.|b NIHR Biomedical Research Centre , Guy's and St Thomas' NHS Foundation Trust and King's College London , London , UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Greenough
authors.affiliation: c Neonatal Intensive Care Centre , King's College Hospital NHS Foundation Trust , London , UK.
authors.forename: Ingran
authors.initials: I
authors.lastname: Lingam
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010102:Oxygen Inhalation Therapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*
keywords: continuous positive airway pressure; heated; high flow nasal cannula; high frequency oscillatory ventilation; humidified; patient triggered ventilation; volume targeted ventilation