ABSTRACT
The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial. One cause is ventilatorinduced lung injury (VILI). Experimental studies show that the magnitude of volutrauma is more closely associated with ventilator-induced lung injury rather than end-inspiratory pressure. The volume guarantee (VG) mode, studied most thoroughly, provides automatic weaning of peak pressure in response to improving lung compliance and respiratory effort. A more consistent tidal volume, fewer excessively large breaths, lower peak pressure, less hypocarbia and lower levels of inflammatory cytokines have been documented. These short-term benefits translate into a shorter duration of ventilation.
ABSTRACT
Advances in neonatal care have led to significant improvements in the survival of preterm infants. However, bronchopulmonary dysplasia (BPD) continues to be a major problem in these infants. BPD is in part thought to be the result of ventilator-induced lung injury. A number of modifications to pressure-limited ventilation have been developed to combine the advantages of pressure-limited ventilation with the benefits of controlling delivered tidal volume. These modalities are designed to deliver a targeted tidal volume by microprocessor-directed adjustments of inspiratory pressure or time. These new choices in ventilator technology can make it difficult to select the most appropriate mode for each infant. Each mode has advantages and disadvantages, with limited data available to judge their effectiveness.