Neonatal ventilation

Abstract

Adequately ventilating the lungs is crucial in neonates since both hypo- and hyperventilation may confer respiratory and systemic consequences, in addition to contributing to the increased morbidity and mortality in pediatric anesthesia. Recently, enormous efforts have been expended to improve ventilation strategies in neonates using a “protective” and “open-lung” strategy in order to maintain optimal functional residual capacity (FRC) and to prevent ventilation-induced lung injury and bronchopulmonary dysplasia. An increased awareness of the potential harm of hyperventilating the lungs of neonates with large tidal volumes (Vt) that can lead to alveolar overdistension due to excessive shear forces and the liberation of proinflammatory cytokines, which constitute the main features of the so-called ventilation-induced lung injury, have caused a reappraisal of such a practice. Moreover, the resultant hypocapnia from hyperventilation may induce cerebral vasoconstriction and promote the development of cystic periventricular leukomalacia