Neue beatmungsstrategien in der neonatologie

Abstract

The introduction of exogenous surfactant therapy along with improvements in infant ventilator design during the last decades have significantly helped to improve survival of Very Low Birth Weight Infants. New ventilatory strategies,such as High Frequency Ventilation, Synchronized Ventilation, and Proportional Assist Ventilation are now commercially available. Some of these technologies are widely used by clinicians in neonatal care. The following review summarizes the available data from studies investigating the effects of these new ventilatory modalities on physiological variables with particular emphasis on data from randomized controlled trials. Based on currently available evidence it does not seem justified to recommend widespread use of High Frequency Ventilation for treatment of Respiratory Distress Syndrome, because significant risks appear to be associated with this approach. Synchronized mechanical ventilation is associated with a number of positive effects on physiological variables, however, randomized controlled trials have not shown significant positive effects on clinically important outcome variables. Volume-controlled ventilatory modes are associated with lower airway pressures. However, there is little information available regarding long-term use. Proportional Assist Ventilation is a new approach of ventilatory support, and short-term studies suggest potential benefits, however, randomized controlled trials using this new technique for more than several hours are currently unavailable. © Springer-Verlag 2002.