New modes of ventilation in paediatrics

  • G. A. Marraro
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Since its first extensive use during the polio epidemics of the 1950s, mechanical ventilation has proved to be of undoubted value in improving survival in many patients affected by severe respiratory failure of varying origin. In the last 25 years, artificial ventilation has tremendously improved the recovery of neonates, especially those born prematurely. However, mechanical ventilation can, in itself, result not only in pulmonary damage (interstitial emphysema, alveolar and bronchiolar damage, pneumothorax, and bronchopulmonary dysplasia) but also in damage to other organs, specifically when high FiO2 has been used (i.e., retrolental fibroplasia) [1–4].


Continuous Positive Airway Pressure Tidal Volume Pressure Support Pressure Support Ventilation Bronchopulmonary Dysplasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Northway WH, Rosan RC, Porter DY (1967) Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 276:357–368PubMedCrossRefGoogle Scholar
  2. 2.
    Goetzman BW (1986) Understanding bronchopulmonary dysplasia. Am J Dis Child 140:332–334PubMedGoogle Scholar
  3. 3.
    Chambers HM, van Velzen D (1989) Ventilator-related pathology in the extremely immature lung. Pathology 21:79–83PubMedCrossRefGoogle Scholar
  4. 4.
    Wohl MEB (1990) Bronchopulmonary dysplasia in adulthood. N Engl J Med 323:1834–1836PubMedCrossRefGoogle Scholar
  5. 5.
    Kafer ER (1971) Pulmonary oxygen toxicity. A review of the evidence for acute and chronic oxygen toxicity in man. Br J Anaesth 43:687–695PubMedCrossRefGoogle Scholar
  6. 6.
    Holm BA, Matalon S, Finkelstein JH, Notter RH (1988) Type II pneumocyte changes during hyperoxic lung injury and recovery. J Appl Physiol 65:2672–2678PubMedGoogle Scholar
  7. 7.
    Saugstad OD (1985) Oxygen radicals and pulmonary damage. Pediatr Pulmonol 1:167–175PubMedCrossRefGoogle Scholar
  8. 8.
    Nilsson R, Grossmann G, Robertson B (1980) Pathogenesis of neonatal lung lesions induced by artificial ventilation: evidence against the role of barotrauma. Respiration 40:218–225PubMedCrossRefGoogle Scholar
  9. 9.
    Kolobow T, Moretti MP, Fumagalli R, Mascheroni D, Prato P, Chen V, Joris M (1987) Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. Am Rev Respir Dis 135:312–315PubMedGoogle Scholar
  10. 10.
    Dreyfuss D, Soler P, Basset G, Saumon G (1988) High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive endexpiratory pressure. Am Rev Respir Dis 137:1159–1164PubMedGoogle Scholar
  11. 11.
    Tsuno K, Prato P, Kolobow T (1990) Acute lung injury from mechanical ventilation at moderately high airway pressures. J Appl Physiol 69:956–961PubMedGoogle Scholar
  12. 12.
    Dreyfuss D, Saumon G (1992) Barotrauma is volutrauma, but which volume is the one responsible? Intensive Care Med 18:139–141PubMedCrossRefGoogle Scholar
  13. 13.
    Slutsky AS (1993) Mechanical ventilation. Chest 104:1833–1859PubMedCrossRefGoogle Scholar
  14. 14.
    Maclntyre NR (1993) Clinically available new strategies for mechanical ventilatory support. Chest 104:560–565CrossRefGoogle Scholar
  15. 15.
    Tobin MJ (1994) Mechanical ventilation. N Eng J Med 330:1056–1061CrossRefGoogle Scholar
  16. 16.
    Slustsky AS (1994) Consensus conference on mechanical ventilation. Intensive Care Med 20:64–79CrossRefGoogle Scholar
  17. 17.
    Stewart TE, Slutsky AS (1995) Mechanical ventilation: a shifting philosophy. Curr Opinion Crit Care 1:49–56Google Scholar
  18. 18.
    Smith BE (1990) High frequency ventilation: past, present and future? Brit J Anaesth 65:130–138PubMedCrossRefGoogle Scholar
  19. 19.
    The HIFI Study Group (1989) High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants. N Engl J Med 320:88–93CrossRefGoogle Scholar
  20. 20.
    Kinsella JP, Clark RH (1993) High-frequency oscillatory ventilation in paediatric critical care. Crit Care Med 21:174–175PubMedCrossRefGoogle Scholar
  21. 21.
    Arnold JH (1996) High frequency oscillatory ventilation: theory and practice in paediatric patients. Paediatr Anaesth 6:437–441PubMedCrossRefGoogle Scholar
  22. 22.
    Carter MJM, Gerstmann DR, Clark MRH, Snider MG, Cornish JD, Null DM, deLemos RA (1990) High-frequency oscillatory ventilation and extracorporeal membrane oxygenation for the treatment of acute neonatal respiratory failure. Pediatrics 85:159–164PubMedGoogle Scholar
  23. 23.
    Man GCW, Ahmed IH, Logus JW, Man SFP (1987) High-frequency oscillatory ventilation increases canine pulmonary epithelial permeability. J Appl Physiol 63:1871–1876PubMedGoogle Scholar
  24. 24.
    Clark RH, Wiswell TE, Null DM, deLemos RA, Coalson JJ (1987) Tracheal and bronchial injury in high-frequency oscillatory ventilation compared with conventional positive pressure ventilation. J Pediatr 111:114–118PubMedCrossRefGoogle Scholar
  25. 25.
    Mammel MC, Ophoven JP, Lewallen PK, Gordon MJ, Boros SJ (1991) Acute airway injury during high-frequency jet ventilation and high-frequency oscillatory ventilation. Crit Care Med 19:394–398.PubMedCrossRefGoogle Scholar
  26. 26.
    Nielsen JB, Sjostrand UH, Edgren EL, Lichtwarck-Aschoff M, Svensson BA (1991) An experimental study of different ventilatory modes in piglets in severe respiratory distress induced by surfactant depletion. Intensive Care Med 17:225–233PubMedCrossRefGoogle Scholar
  27. 27.
    Sjostrand UH, Lichtwarck-Aschoff M, Nielsen JB, Markstrom A, Larrson A, Svensson BA, Wagenius GA, Nordgren KA (1995) Different ventilatory approaches to keep the lung open. Intensive Care Med 21:310–318PubMedCrossRefGoogle Scholar
  28. 28.
    Marraro G (1994) Pressure support ventilation (PSV) and pressure regulated volume control (PRVC): new methods of ventilation for newborns. In: Minoli I (ed) Neonatal Intensive Care. 16th Inter Symp, Sanremo, pp 33–34Google Scholar
  29. 29.
    Marraro G (1998) Intraoperative ventilation in paediatrics. Paediatric Anaesthesia 8:373–382PubMedCrossRefGoogle Scholar
  30. 30.
    Marraro G (1997) New modes of pulmonary ventilation. In: Dalens B, Murat I, Bush G (eds) Advances in paediatric anaesthesia. FEAPA, Paris, pp 57–88Google Scholar
  31. 31.
    Hazelzet JA (1992) New ventilatory modes in severe respiratory failure. (Abstract). First World Congress of Pediatric Intensive Care, BaltimoreGoogle Scholar
  32. 32.
    Marraro G (1994) Pressure regulated volume control ventilation and pressure support ventilation. CME Programme, Jaipur, pp 32–33Google Scholar
  33. 33.
    Marraro G, Mannucci F, Galbiati AM et al (1994) The advantages of a new mode of artificial ventilation: pressure regulated volume controlled (PRVC) ventilation. Pediatr Res 35(Suppl A344):2047Google Scholar
  34. 34.
    Marraro G, Casiraghi G, Galbiati AM (1995) A study of pressure regulated volume control ventilation in natural surfactant treated infants with RDS. Pediatr Res 4(Suppl A223):1321Google Scholar
  35. 35.
    Mori N, Suzuki M (1994) Trigger sensitivity of Servo 300 (Siemens Elema) for pressure support ventilation in an infant. Paediatr Anaesth 4:27–34CrossRefGoogle Scholar
  36. 36.
    Marraro G (1994) Selective endobronchial intubation in paediatrics: the Marraro Paediatric Bilumen Tube. Paediatr Anaesth 4:255–258CrossRefGoogle Scholar
  37. 37.
    Marraro G (1987) Synchronized independent lung ventilation in pediatric age. ACP Applied Cardiopulm Pathophys 2:283–288Google Scholar
  38. 38.
    Marraro G, Marinari M, Rataggi M (1987) The clinical application of SILV in pulmonary disease with unilateral prevalence in pediatrics. Int J Clin Mornit Comput 4:123–129CrossRefGoogle Scholar
  39. 39.
    Marraro G (1990) Ventilation à poumons separés chez l’enfant au cours de la l.ère année de vie. Cah Anaesthesiol 38:377–380Google Scholar
  40. 40.
    Marraro G (1992) Simultaneous independent lung ventilation in pediatric patients. Crit Care Clin 8:131–145PubMedGoogle Scholar
  41. 41.
    Versprille A, Hrachovina V, Jansen JRC (1995) Alternating versus synchronous ventilation of left and right lungs in piglets. Intensive Care Med 21:1009–1015PubMedCrossRefGoogle Scholar
  42. 42.
    Frostell C, Hedenstierna G, Cronestrand R (1995) Asynchronous ventilation in the dogs: effects on lung blood flow and gas exchange. Clin Physiol 5(Suppl 3):59–64Google Scholar
  43. 43.
    Colombo A, Dell’Avo A, Nacci A, Personeni O, Spada P (1987) Hospital procedure and nursing for patients treated with synchronized independent lung ventilation (sILV). Intensive Care Nurs 3:117–124PubMedCrossRefGoogle Scholar
  44. 44.
    Brochard L, Pluskwa F, Lemaire F (1987) Improved efficacy of spontaneous breathing with inspiratory pressure support. Am Rev Respir Dis 136:411–415PubMedCrossRefGoogle Scholar
  45. 45.
    Mori N, Suzuki M (1994) Trigger sensitivity of Servo 300 (Siemens Elema) for pressure support ventilation in an infant. Paediatr Anaesth 4:27–34CrossRefGoogle Scholar
  46. 46.
    Tokioka H, Kinjo M, Hirakawa M (1993) The effectiveness of pressure support ventilation for mechanical ventilatory support in children. Anaesthesiology 78:880–884CrossRefGoogle Scholar
  47. 47.
    Bonmarchand G, Chevron V, Chopin C, Jusserand D, Girault C, Moritz F, Leroy J, Pasquis P (1996) Increased initial flow rate reduces inspiratory work of breathing during pressure support ventilation in patients with exacerbation of chronic obstructive pulmonary disease. Intensive Care Med 22:147–154CrossRefGoogle Scholar
  48. 48.
    Brochard L, Harf A, Lorino H, Lemaire F (1989) Inspiratory pressure support prevents diaphragmatic fatigue during weaning from mechanical ventilation. Am Rev Respir Dis 139:513–521PubMedCrossRefGoogle Scholar
  49. 49.
    Kacmarek RM(1988) The role of pressure support ventilation in reducing work of breathing. Respir Care 33:99–120Google Scholar
  50. 50.
    Esteban A, Frutos F, Tobin MJ (1995) A comparison of four methods of weaning from mechanical ventilation. N Engl J Med 332:345–350PubMedCrossRefGoogle Scholar
  51. 51.
    Mancebo J, Amaro P, Mollo JL, Lorino H, Lemaire F, Brochard L (1995) Comparison of the effects of pressure support ventilation delivered by three different ventilators during weaning from mechanical ventilation. Intensive Care Med 21:913–919PubMedCrossRefGoogle Scholar
  52. 52.
    Kanak R, Fahey PJ, Vanderward C (1985) Oxygen cost of breathing: changes dependent upon mode of mechanical ventilation. Chest 87:126–127PubMedCrossRefGoogle Scholar
  53. 53.
    Gullberg N, Wimberg P, Selldèn H (1996) Pressure support ventilation increase cardiac output in neonates and infants. Paediatr Anaesth 6:311–315PubMedCrossRefGoogle Scholar
  54. 54.
    Hird MF, Greenough A (1991) Patient triggered ventilation in chronically ventilator-dependent infants. Eur J Pediatr 150:732–734PubMedCrossRefGoogle Scholar
  55. 55.
    Fiastro JF, Quan BF, Habib MP (1986) Pressure support compensation for inspiratory work due to endotracheal tubes and demand CPAP. Chest 89:441SGoogle Scholar
  56. 56.
    Kylstra JA, Tissing MO, Van der Maen A (1962) Of mice as fish. Trans Am Soc Artif Intern Organs 8:378–383PubMedCrossRefGoogle Scholar
  57. 57.
    Clark LC, Gollan F (1966) Survival of mammals breathing organic liquids equilibrated with oxygen at atmophere pressure. Science 152:1755–1756PubMedCrossRefGoogle Scholar
  58. 58.
    Moskowitz GD (1970) A mechanical respirator for control of liquid breathing. Fed Proc 29:1751–1752PubMedGoogle Scholar
  59. 59.
    Shaffer TH, Lowe CA, Bhutani VK, Douglas PR (1983) Liquid ventilation: effects on pulmonary function in meconium stained lambs. Pediatr Res 19:49–53Google Scholar
  60. 60.
    Shaffer TH, Wolfson MR, Clark LC (1992) Liquid ventilation. Pediatr Pulmunol 14:102–109CrossRefGoogle Scholar
  61. 61.
    Fuhrman BP, Paczan PR, De Francisis M (1991) Perfluorocarbon-associated gas-exchange. Crit Care Med 19:712–722PubMedCrossRefGoogle Scholar
  62. 62.
    Lachmann B, Tucuncu AS, Bos JA, Faithfull NS (1991) Intratracheal perfluorooctylbro-mide (PFOB) in combination with mechanical ventilation. International Society for Oxygen Transport to Tissues, Willemstand, A24–A30Google Scholar
  63. 63.
    Fuhrman BP (1990) Perfluorocarbon liquid ventilation: the first human trial. J Pediatr 117:73–74PubMedCrossRefGoogle Scholar
  64. 64.
    Marraro G (1997) La ventilation liquide partielle. Cah Anaesthesiol 45:383–388Google Scholar
  65. 65.
    Marraro G, Bonati M, Ferrari A, Barzaghi MM, Pagani C, Bortolotti A, Galbiati AM, Luchetti M, Croce A (1998) Perfluorocarbon bronchoalveolar lavage and liquid ventilation versus saline bronchoalveolar lavage in adult guinea pigs experimental model of meconium inhalation. Intensive Care Med 24:501–508PubMedCrossRefGoogle Scholar
  66. 66.
    Foust R III, Tran NN, Cox C, Miller TF, Greenspan JS, Wolfson MR, Shaffer TH (1996) A liquid assisted ventilation: an alternative ventilation strategy for acute meconium aspiration injury. Pediatr Pulmonol 21:316–322PubMedCrossRefGoogle Scholar
  67. 67.
    Shaffer TH, Wolfson MR (1996) Liquid ventilation an alternative ventilation strategy for management of neonatal respiratory distress. Eur J Pediatr 155(Suppl 2):30–34CrossRefGoogle Scholar
  68. 68.
    Lowe Leach C, Greenspan JS, Rubenstein SD, Shaffer TH, Wolfson MR, Jackson JC, DeLemos R, Fuhrman BP, for the Liqui Vent Study Group (1996) Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. N Engl J Med 335:761–767PubMedCrossRefGoogle Scholar
  69. 69.
    Gauger PG, Prenikoff T, Schreiner RJ, Moler FW, Hirschl RB (1996) Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome. Crit Care Med 24:16–22PubMedCrossRefGoogle Scholar
  70. 70.
    Hirschl RB, Tooley R, Parent A, Johnson K, Bartelett RH (1996) Evaluation of gas exchange, pulmonary compliance, and lung injury during total and partial liquid ventilation in the acute respiratory distress syndrome. Crit Care Med 24:1001–1008PubMedCrossRefGoogle Scholar
  71. 71.
    Modell JH, Tham MK, Calderwood HW, Ruiz BC (1973) Distribution and retention of fluorocarbon in mice and dogs after injection or liquid ventilation. Toxicol Appl Pharmacol 26:86–92PubMedCrossRefGoogle Scholar
  72. 72.
    Shaffer TH, Wolfson MR, Greenspan JS, Hoffman RE, Davis SL, Clark Jr LC (1996) Liquid ventilation in premature lambs: uptake, biodistribution and elimination of perfluorodecalin liquid. Reprod Fertil Dev 8:409–416PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • G. A. Marraro

There are no affiliations available

Personalised recommendations