Neonatal pressure support ventilation: are we doing what we think we are doing?

Assisted modes of mechanical ventilation, including synchronous intermittent mandatory ventilation, pressure support ventilation (PSV), continuous mandatory ventilation, neurally adjusted ventilatory assist, and volume guarantee ventilation, are widely used in neonates, infants, and small children to achieve improved short-term and long-term outcomes.1-3 Specifically, evidence is accumulating that the various assisted modes of ventilation are associated with increased patient comfort, decreased work of breathing, decreased diaphragmatic dysfunction, less risk of air leak, shorter duration of weaning, and significant reduction in bronchopulmonary dysplasia.3-6 Despite these improvements in ventilatory modes and their associated technology, pulmonary complications of prematurity, including bronchopulmonary dysplasia, pneumothorax, pulmonary interstitial emphysema, and need for long-term mechanical ventilation, remain agonizingly common, suggesting that we have significant room for improvement in our ability to provide optimal ventilatory support for our patients.7,8