Complications of Positive Pressure Ventilation

The adaptation of mechanical ventilators for use in the neonatal population brought about a dramatic breakthrough in the care of premature infants. Further refinements and the development of technologies such as high-frequency ventilation combined with exogenous surfactant have further pushed back the boundaries of survival. Despite these advances, mechanical ventilation is not without risk. Barotrauma and volutrauma, resulting from the mechanical effects of positive pressure, and oxygen toxicity have harmful effects on many neonatal organs, including the lungs, heart, kidneys, eyes, and brain. Of special importance to all neonatal nurses is the risk for infection and airway trauma resulting from placement and use of the endotracheal tube. This chapter begins with a general discussion of lung trauma associated with volume, pressure, atelectasis, and oxygen. A review of some of the most common complications of mechanical ventilation—air leak syndromes, airway injury, pulmonary hemorrhage, and bronchopulmonary dysplasia (BPD)—follows. Patent ductus arteriosus (PDA) and retinopathy of prematurity (ROP) and their relationship to oxygen therapy are also discussed.