Mechanical ventilation has inherent risks, including infection, barotrauma, volutrauma, bronchopulmonary dysplasia, and lung injury.
Increased levels of supplemental oxygen during mechanical ventilation can result in retinopathy of prematurity and lung injury from excessive arterial oxygen levels.
Time-triggered, pressure-limited, and time-cycled mechanical ventilation is a mode that the respiratory therapist (RT) sets to provide a continuous flow of heated and humidified air to the patient through positive pressure ventilation via an artificial airway. This mode of mechanical ventilation is used to support or improve ventilation and oxygenation.
Most neonates are ventilated because of immaturity of lung tissue or respiratory distress syndrome (RDS). The primary goal of mechanical ventilation is to support breathing and oxygenation while using protective lung strategies to minimize potential damage to the neonate’s lungs.
Time-triggered, pressure-limited, and time-cycled mechanical ventilation is achieved using ventilators specifically designed to ventilate neonates using this mode. These ventilators require capabilities, including the ability to generate low tidal volumes (VTs) and low flows and to sense low-flow and low-pressure changes and other very small dynamic changes generated by the patient.
With time-triggered, pressure-limited, and time-cycled mechanical ventilation, inspiration is triggered by time. Expiration is also cycled or initiated by time. However, the breath is limited by pressure, and when a certain pressure is reached, the unnecessary flow is diverted away from the patient.
Mechanical ventilation can produce negative outcomes in the neonatal patient. One concern involves the patient’s head position during care. Research suggests that the head position may affect cerebral hemodynamics and contribute to the development of germinal matrix‐intraventricular hemorrhage (GM‐IVH) in very preterm neonates.undefined#ref3">3 Turning the head toward one side may occlude jugular venous drainage while increasing intracranial pressure and cerebral blood volume.3 It is suggested that cerebral venous pressure is reduced and hydrostatic brain drainage improved if the patient is cared for in the supine, head midline position.3
Neonates ventilated using a volume-targeted mode of ventilation (VTV) were more likely to suffer no lung damage, and had reduced rates of death or complications, including bronchopulmonary dysplasia, pneumothoraces, hypocarbia, severe cranial pathologies, and duration of ventilation compared with patients ventilated using pressure‐limited ventilation (PLV) modes.2
Neonatal ventilation modes can target a set VT as an alternative to traditional PLV using a fixed inflation pressure. VTV aims to produce a more stable VT to reduce lung damage and stabilize the partial pressure of carbon dioxide (PCO2).2
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Rationale: A useful clinical indicator of adequate PIP is a gentle chest rise with every breath; a gentle chest rise indicates that the patient has normal chest excursion and adequate breath sounds.
Use the lowest possible PIP to achieve adequate gas exchange and visible chest rise. Avoid excessive PIP to minimize barotrauma.
Rationale: Changes in lung compliance can alter the VT delivered to the patient and cause volutrauma or hypoventilation.
Rationale: Pressure on the patient’s lips or gums from the ET tube results in breakdown in the area of contact. Tension or pressure on the tube can result in unplanned extubation or right main stem intubation.
Rationale: An alarm may be associated with the need for suctioning, the need to drain water from the tubing, or a disconnection of the tubing.
Elshiekh, A.R.M.H., Nosair, A.I., Elshazly, E.M.M.R. (2020). Effect of change in newborn’s position during mechanical ventilation on oxygenation. Egyptian Journal of Hospital Medicine, 80(3), 997-1002. doi:10.21608/EJHM.2020.106015
Kacmarek, R.M. (2021). Chapter 49: Initiating and adjusting invasive ventilatory support. In R.M. Kacmarek, J.K. Stoller, A.J. Heuer (Eds.), Egan’s Fundamentals of Respiratory Care (12th ed., pp. 1072-1104). St. Louis: Elsevier.
*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.
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