New and alternative modes of mechanical ventilation in neonates.

Innovative ventilation modes for infants attempt to reduce volume-induced lung damage, to decrease airway pressure and oxygen exposure, and to improve patient comfort. Volume-targeted ventilation results in more consistent tidal volumes, allows automatic weaning of airway pressure, may avoid hypocapnia and may be associated with long-term clinical benefits. Pressure support ventilation allows the patient to control the duration of mechanical breaths. It requires a stable respiratory drive or back-up for apnoea. Pressure support ventilation may be effective for weaning. Proportional assist ventilation was studied in small animal species. In preterm infants with acute and chronic lung disease, ventilator pressure requirements were lower in cross-over short-term comparisons with conventional triggered ventilation. Neurally adjusted ventilatory assist delivers ventilator pressure in proportion and in synchrony with the phasic inspiratory diaphragmatic electrical activity obtained from intra-oesophageal electrodes. Large multicentre clinical trials are required to prove long-term clinical benefits of these new modes.