Mechanical ventilation is used to assist breathing for neonates who are unable to breathe sufficiently on their own. In the neonatal intensive care unit (NICU) setting, mechanical ventilation is often a major driver of both cost and duration of care.
Mechanism of Action
There are three main types of mechanical ventilation. Pressure ventilators are the most common, and deliver air to a pre-set peak inspiratory pressure. Volume ventilators deliver air to a pre-set tidal volume (around 5-7mL/kg in a 1.2kg infant). High frequency ventilators operate at 180-900 breaths per minute with extremely small tidal volumes, allowing ventilation when conventional means have failed. Complex, modern ventilators can trigger and adjust flow based on the patient’s spontaneous breath. These features may offer advantages to some patients but have not been shown to decrease mortality. In all cases, ventilation is designed to support the infant to the point that she matures enough to breathe on her own. In many cases, prolonged use can cause lung injury.
Current Use in High-Resource Settings
Although intubation is not always necessary, the majority of patients who require ventilation get an endotracheal tube which connects to the ventilation apparatus. Depending on their condition, neonates can remain on ventilators for days to weeks.
Application in Low-Resource Settings
The high cost of ventilators and the high level of skill required to operate, maintain, and repair the ventilators mean that ventilators are used almost exclusively in well equipped neonatal intensive care units. Low-resource health care providers in developing settings have less training and experience with mechanical ventilation, thus causing increased morbidity through pneumothorax and other lung injury.
Related Technologies in Development
BU/MIT Ventilator, Morrison Pneumatic Ventilator, Onebreath Ventilator, Seattle Children's Hansen Ventilator