Mechanical ventilation in newborns
Risk of neurodevelopmental impairment
Mechanical Ventilation and Brain Injury Risks after 1 or 5 days of ventilation
“There is a lower risk of BPD development, if infants do not require artificial invasive ventilation“
Association between mechanical ventilation and lung injury (VALI)
However there is still more than 50% of ELGA infants, who require mechanical ventilation.
Need for Mechanical Ventilation
12 PCIP in 2017
Traumas Contribute To Ventilator Induced Lung Injury- VILI
- Barotrauma 1973
- Volutrauma 1988
- Atelectrauma 1997
Oxygen toxicity
- Ergotrauma 2016
Ergotrauma
Absorption of mechanical energy exceeding a compensation ability of lung tissue
- Tpt = K x ΔV/V0
- Tpt…transpulmonary pressure
- K…specific lung compliance
- ΔV…change of lung volume
- V0… initial lung volume
Specific lung compliance = pressure needed for two time FRC achievement
PREVENTION Of LUNG INJURY
„Keeping the lung open“
Recruitment and Stabilization 
Approximation Of Protective CV and HFV
Strategy OPTIMUM LUNG VOLUME with minimal V/Q imbalance
Keep in your mind!
Characteristic of lung disease
- Homogeneous, IRDS
- Heterogeneous, disperse, focal
- Acute or chronic
Biophysical properties of lung
- Compliance, Crs = ΔV/ ΔP
- Resistance, R = (P1-P2)/V
- Time Constant, TC = C x R
Phase of MV related to lung
- Recruitment
- Stabilisation
- Weaning and extubation
Postulates of “KNOWLEDGES“ to minimise iatrogenic lung injury:
- ALL TOGETHER
- Biophysical properties of lung (dg. and pathophysiology of lung)
- Phase of lung disease (recruitment-stabilization-weaning)
- Specifics of ventilatory devices and modes
Basics of „LUNG HOMOGENIZATION“
- Adequate alveolar distension during the whole of respiratory cycles
- Respecting of time constants in different lung compartments
- Positioning
Ventilatory parameters related to homogenization of lung:
In favor of…:
- ↑MAwP/FiO2
- ↑Frequency (Hf)
- ↓ VT
Against…:
- ↓ MAwP/FiO2
- ↑ Frequency IMV
- ↑ VT
Adverse effect of high intrathoracic (intrapulmonary pressure):
- Dopamin 2-5 ug/kg/min
- Dobutamin 10-20ug/kg/min
- Volumexpansion
Prone position during ventilators support
- Increases the elasticity of thorax
- Homogenize distribution of lung liquid content
- Facilitate recruitment of dorsal regions of lung (dependent regions)
Improvement
- V/Q proportion
- Distribution and exchange of gases
- Mobilisation of secretion
TRIAS of SUCCESS:
STRATEGY – VENTILATORY MODE - MANAGEMENT
STRATEGY „OPTIMUM LUNG VOLUME“
With adequate distribution of VTs to stabilized alveoli (PEEP a MAwP) during the all whole respiratory cycles
IS A KEY
Appropriate choice of ventilatory mode related to the current lung pathology makes management easier may attenuates negative effects of MV.
MODE IS A MEDIATOR
Only educated and well skilled doctors familiar with device can provide successful management
MANAGEMENT IS A PROCESS!
Back Up
Keep always in your mind!
Mechanisms VALI/VILI
- Excessive VT and Low EEP EEP
- High FiO2
- Low lung volume and very uneven distribution of gas
Phases of MV
- Recruitment
- Stabilisation
- Weaning and Extubation
Trauma