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Schmölzer, GM; Te Pas, AB; Davis, PG; Morley, CJ.
Reducing Lung Injury during Neonatal Resuscitation of Preterm Infants.
J Pediatr. 2008; 153(6): 741-745.
Doi: 10.1016/j.jpeds.2008.08.016
Web of Science
PubMed
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FullText_MUG
- Leading authors Med Uni Graz
- Schmölzer Georg
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- Abstract:
- Neonatologists are familiar with the concept of ventilator-induced lung injury (VILI)(1,2) and are increasingly careful in the neonatal intensive care unit (NICU) to apply positive-pressure ventilation (PPV) strategies that are gentle to the lungs.(3) Although PPV also is commonly used in the delivery room (DR), clinicians appear less aware that the same gentle approach should be applied to reduce lung injury during the first few minutes of life. To achieve adequate gas exchange after delivery, lung fluid is cleared and replaced with air, and functional residual capacity (FRC) is established. Mechanical ventilation requires an appropriate minute volume to achieve adequate gas exchange. Clinical signs are used to evaluate the response to ventilation during neonatal resuscitation. The tidal volume (V-T) delivered is rarely measured; thus, airway pressure is not adjusted to optimize V-T and reduce volutrauma or underventilation.(4-6) The use of end-expiratory pressure, considered essential to avoid lung injury in the NICU, is still not uniformly applied in the DR. PPV may cause lung injury through various mechanisms, including high airway pressure (barotrauma), high VT and overdistention (volutrauma), repeated alveolar collapse and reexpansion (atelectrauma), and infection and inflammation (biotrauma).(1) These injuries cause leakage of proteinaceous fluid and blood into the airways, alveoli, and lung interstitium, inhibiting surfactant function, interfering with lung mechanics, and contributing to lung injury.(1) In this review, we describe what is known about the causes of neonatal lung injury, based on animal and human research. Although human data are scanty, and randomized control trials are needed, we suggest ways in which current practice might be changed to help minimize lung injury during neonatal resuscitation.
- Find related publications in this database (using NLM MeSH Indexing)
- Animals -
- Continuous Positive Airway Pressure - adverse effects
- Equipment Failure -
- Humans -
- Infant, Newborn -
- Infant, Premature -
- Intensive Care Units, Neonatal -
- Masks -
- Oximetry -
- Oxygen - administration and dosage
- Pulmonary Atelectasis - etiology
- Resuscitation - adverse effects
- Ventilator-Induced Lung Injury - etiology