Mechanical ventilation and lung injury

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Perhaps the only consensus about mechanical ventilation of infants is that, all else being equal, avoidance of mechanical ventilation is the best way to avoid lung injury. All agree that the least injurious ventilation technique should be used. We know from animal studies and clinical experiences that the lung can be injured by “volutrauma”—defined as high tidal volumes that approach maximal lung volumes. Logically, tidal volume targeted ventilation should avoid the variable and sometimes high volumes that occur with pressure limited ventilation, but in practice does it improve outcomes? Singh et al report that volume targeted ventilation decreased the time to achieve oxygenation or mean airway pressure goals relative to pressure limited ventilation for infants with RDS. Davis, in an editorial, puts this short term outcome trial into perspective and points out that volume targeted ventilation has not clearly resulted in improved longer term outcomes. The results suggest that volume targeted ventilation may decrease lung injury marginally relative to conventional ventilation for preterm infants but that bronchopulmonary dysplasia and neurodevelopmental outcomes are not easily improved by changing mechanical ventilation management practices.