High Frequency Ventilation as the Primary Modes of Respiratory Support for ELBW

Respiratory management of the extremely low birth weight (ELBW) newborn has evolved over time. Although non-invasive ventilation is being increasingly used for respiratory support in these ELBW infants, invasive ventilation still remains the primary mode in this population. Current ventilators are microprocessor driven and have revolutionized the respiratory support for these neonates synchronizing the baby's breath to ventilator breaths. High frequency ventilators with the delivery of tidal volumes less than the dead space have been introduced to minimize barotrauma and chronic lung disease. Despite these advances, the incidence of chronic lung disease has not decreased. There is still controversy regarding which mode is ideal as the primary mode of ventilation in ELBW infants. The most common modes seem to be pressure targeted conventional ventilation, volume targeted conventional ventilation and high frequency ventilation which includes high frequency oscillatory ventilation, high frequency jet ventilation and high frequency flow interrupter. In recent years, several randomized controlled trials and meta-analyses have compared volume vs. pressure targeted ventilation and high frequency ventilation. While volume targeted ventilation and high frequency ventilation does show promise, substantial practice variability among different centres persists. The rate of preterm birth (<37 weeks) in the USA has decreased between 2007 and 2014 by 8%. Extremely low birth weight (ELBW) babies occupy a large portion of the current population of preterm infants with gestational ages ranging from 22 to 28 weeks. With significant advances in the care of new-borns, the high mortality among the ELBW population has been replaced by increased survival but with significant long-term morbidity. Several collaborative improvement projects and network studies have been undertaken between countries and centres with the evaluation of outcomes among the ELBW population.

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John
Editorial Assistant
Clinical Pediatrics Open Access