How is neonatal ventilation performed in the NICU?

The primary types of ventilation performed in the NICU are:
  • CPAP (continuous positive airway pressure) is used to keep the infant’s lungs open, to make expansion easier and to prevent collapse. CPAP decreases the work of breathing for the infant while increasing functional residual capacity, thereby improving both oxygenation and ventilation
  • Conventional mechanical ventilation is used to deliver breaths. Mechanical ventilation can be either IMV (intermittent mandatory ventilation) where the rate of breathing in determined by the machine; SIMV (synchronized IMV) where the ventilator times breaths to coincide with the baby’s inspiratory effort; or assist control where the infant determine the rate but the machine determine the size of the breath.
  • High Frequency Ventilation is reserved for infants not responding to conventional mechanical ventilation. High Frequency Ventilation allows for effective ventilation with smaller tidal volumes but has some negative effects on cardiac function.
The choice about the type of ventilation used is a complex decision based on the infant’s medical diagnosis, condition, blood gas values and other factors unique to each individual clinical situation.

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