Advances in neonatal conventional ventilation.

Despite the implementation of several alternative strategies for management of respiratory failure in neonates, such as extracorporeal membrane oxygenation, high frequency ventilation, and nitric oxide, conventional assisted ventilation remains the mainstay of treatment. This has traditionally been accomplished by time cycled, pressure limited ventilators over the past three decades primarily because of its ease of application and relative safety. However, several recent advances, both in the concept and the application of conventional ventilation, have been introduced for use in neonates. The introduction of newer, state of the art, microprocessor controlled ventilator systems provides clinicians with opportunities to apply a number of advanced ventilatory modalities not previously available for treating newborns. Some of these techniques will need further scientific evaluation in controlled trials, but this should not preclude their use in clinical settings, as their safety has already been proved by "standard setters" for use in neonates. There is a firm physiological rationale for their use, and individual centres have already acquired substantial experience in the application of these modalities. In this paper scientific information and technological advances leading to the newer concepts of ventilatory management in neonates will be addressed, and clinical perspectives based on personal experience will be discussed. Each section includes background information, technical details, clinical application and experience, advantages and limitations, and future perspectives.