Pathophysiological Approach to the Respiratory Management of Preterm Infants with Hypoxic Respiratory Failure, Respiratory Distress Syndrome and Bronchopulmonary Dysplasia

neonatoloji-4-4-2023

Hasan ÖZKANa , Funda TÜZÜNa

aDokuz Eylül University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, İzmir, Türkiye

ABSTRACT
To achieve successful mechanical ventilation, it’s crucial to acknowledge that a uniform approach is not suitable, even within the same population. In this review, respiratory support strategies based on the pathophysiologies of conditions including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), and hypoxic respiratory failure (HRF) in varying scenarios will be discussed, accompanied by examples from our own protocol. Lung protective ventilation strategies and considering early extubation if invasive mechanical ventilation was needed are the main goals of respiratory support in RDS. RDS management comprises strategies to prevent the progressive development of atelectasis, surfactant therapy and optimizing ventilation/perfusion balance. For patients with evolving BPD, the ventilation strategy should be adjusted based on the pathophysiology of the disease, the patient’s lung parenchyma, and pulmonary mechanics. One of the major errors is ventilating infants with BPD as though they are in the acute phase of RDS. HRF management is also challenging and warrant a precise approach depending on the underlying physiopathology. Although there is limited evidence, the cornerstone of therapy of neonatal HRF includes optimizing ventilation, pulmonary pressure reduction and appropriate hemodynamic support according to the underlying pathophysiology. As summarized in this review, it is crucial to customize ventilator parameters, adapting them to the distinct pathophysiology and severity of the underlying pulmonary condition.
Keywords: Infant premature; hypoxic respiratory failure; respiratory distress syndrome; bronchopulmonary dysplasia; lung injury; RDS; neonatal ARDS; precision medicine

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