Refining Ventilation During Neonatal Resuscitation Using Ventilator: Time for a Well-Designed Clinical Study!

Excerpt

Provision of positive pressure ventilation (PPV) to newborns asphyxiated at birth is crucial for establishing a smooth transition to extrauterine life. If unregulated, PPV induces lung injury and may lead to complications. Identifying a safe and effective modality to provide PPV, hence, becomes pivotal. A self-inflating bag (SIB) is the most common modality for providing PPV during resuscitation. The T-piece resuscitator (TPR) is an alternative device that is increasingly being used and can provide positive end expiratory pressure (PEEP) and a set positive inspiratory pressure (PIP). A recent review and meta-analysis found that use of TPR, when compared to other devices, resulted in a decrease in bronchopulmonary dysplasia and PPV duration, but did not affect mortality [1]. In TPR, tidal volume (TV) cannot be measured and respiratory rate (RR) is operator-dependent. In SIB, the PEEP valve and manometer can be attached to address its shortcomings, but the use of such modifications is limited. Since volutrauma is the main determinant of ventilator-induced lung injury, it seems physiologically reasonable to control the TV using a ventilator. …