Premature infants frequently present with respiratory instability that is associated with fluctuations in ventilation and gas exchange. Frequent adjustments of respiratory support to match the infant’s needs are time consuming and are limited by staff availability and workload. Hence, automation is being developed as a way of improving the care of the premature infants and reduce staff workload.
Some of these automated modes of respiratory support are becoming available for clinical use in preterm infants. These include volume targeted ventilation where peak inspiratory pressure is automatically and continuously adjusted to deliver a preset tidal volume. Another modality is targeted minute ventilation where the ventilator rate is adjusted automatically to maintain a preset minute ventilation. Proportional assist ventilation is another modality where airway pressure is adjusted in proportion to flow or tidal volume generated by the infant. Using this principle recently NAVA has been introduced for use in neonates where the airway pressure generated by the ventilator is proportional to the electrical signal captured from the diaphragm. Finally, automated adjustment of inspired oxygen concentration is becoming available in some ventilators to adjust FiO2 and maintain oxygen saturation within a preset range. These modes are expected to compensate for some of the limitations that exist in the present forms of respiratory support. Available evidence and preliminary findings for short term effects are promising but further investigation is needed to determine the effects of these modalities on the long term outcome of preterm infants.
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