NEONATAL RESPIRATORY FAILURE

The current challenge in neonatal ventilatory care is to select among proliferating options that include extracorporeal membrane oxygenation (ECMO), high-frequency ventilation (HFV), and partial liquid ventilation (PLV). More and more options in pressure and flow waveforms, triggering sensors, synchronization options, and breath-by-breath pressure, flow, and volume monitoring are available on conventional ventilators. All of these new options offer value over the ventilatory modes of the 1970s and 1980s that were executed without real understanding of the impact of ventilatory pattern on the evolution of the lung injury process. These novel therapies raise both the therapeutic potential and the complexity of neonatal ventilation to new levels. Such developments make it imperative that we as anesthesiologists understand the individual roles, risks, and benefits of these new approaches.