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Books > Medicine > Clinical & internal medicine > Respiratory medicine
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Non-Invasive Ventilation, An Issue of Clinics in Perinatology, Volume 43-4 (Hardcover)
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Non-Invasive Ventilation, An Issue of Clinics in Perinatology, Volume 43-4 (Hardcover)
Series: The Clinics: Internal Medicine
Expected to ship within 10 - 15 working days
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Preterm birth interrupts the normal developmental progression of
most organs, particularly when birth occurs at the lowest level of
viability. An immediate task is to successfully transition to a
post-natal life without a placental circulation. To do this demands
careful management of the cardiorespiratory systems. To best help
the fragile preterm infant at this demanding time, care-givers must
remember two most pressing goals. These are first to maintain
adequacy of gas exchange and delivery, while simultaneously
minimizing any secondary injury to the fragile preterm lung.
However, after these immediate priorities in the delivery room, the
longer term effects of an immature lung development and its
associated problems come to the forefront. These problems include
the inflammation of perinatal infection, oxygen, and invasive
mechanical ventilation. Both the immaturity itself, and secondary
lung injury and its inflammation - collectively will often lead to
the condition termed bronchopulmonary dysplasia (BPD). Although
many of these infants may eventually be discharged to home without
a need for oxygen supplementation or pulmonary medications, the
long-term impact of interrupted lung development and secondary lung
injury remain serious concerns. It is now well recognized that
mechanical ventilation is pivotal to developing secondary lung
injury and BPD. Consequently, a great deal of time and effort has
been put into the development and application of non-invasive
ventilator (NIV) approaches to supporting respiratory function in
neonates. Since the landmark publication by Gregory and colleagues
in 1967, nasal continuous positive airway pressure (nCPAP) has been
the most commonly applied approach to NIV. This approach has been
supported by the recent generation of randomized controlled trials.
However, cumulatively these trials have shown only a small
reduction in rates of BPD. Outside of the trial data, despite the
wider application of nCPAP, rates of BPD remain relatively
unchanged over recent years. This has led to investigations of
other NIV approaches including nasal ventilation and high flow
nasal cannula therapy. Not only have available modes increased, but
so have the interfaces through which these modes may be applied. In
the issue of Clinic in Perinatology, readers will find an
up-to-date review of non-invasive approaches to supporting preterm
respiratory function. This draws on the expertise of leading
investigators in the field. This issue reviews the physiologic
mechanisms by which the various approaches to NIV may support
respiratory function; the evidence base supporting different NIV
approaches; and adjunctive aspects of NIV therapy including their
use during neonatal transport and the application of other
supportive therapies such as inhaled NO.
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