Comparison of neonatal lung ventilation systems: what is important to know?

Features of ventilation of the lungs in newborns

Artificial ventilation of the lungs is a method used to replace or support respiratory function. Under normal circumstances, a newborn takes their first breaths independently after birth. The doctor evaluates the skin color, respiratory activity, and muscle tone. If the newborn is unable to breathe adequately, medical professionals must provide immediate assistance. Resuscitative measures are employed in the presence of the following signs:

• slow, irregular breathing;

• absence of breathing;

• weak cry;

• cyanosis, pallor of the skin;

• craniospinal trauma;

• seizures;

• pulmonary edema;

• cerebral edema;

• shock.

Indications for ventilation in children arise in cases of congenital diseases such as respiratory distress syndrome, apnea, hypoxemia, hypoventilation, pneumonia, and asphyxia. The method of therapy is chosen by a specialist based on the individual case.

The ventilator delivers an air mixture with the appropriate oxygen concentration into the child's lungs while maintaining the necessary cycle and volume. Most devices consist of a compressor, a group of sensors, output and delivery mechanisms, an electronic control circuit, and a valve system. Transitioning between the phases of inhalation and exhalation occurs according to parameters set by medical personnel.

The main types of ventilation systems for neonatology

For successful ventilation of the lungs in newborns, special equipment such as ventilators  is needed. Devices for neonatology are classified by principles: mechanism of operation, type of drive, operating conditions. Depending on the mechanism of operation, devices are internal and external action, as well as electrostimulators.

Ventilation devices of internal action provide ventilation by delivering a gas mixture. External devices ventilate by applying external pressure to the body. Electrical stimulators of respiration assist in activating the innervation of respiratory muscles and the diaphragm, leading to lung movement. Medical equipment is classified according to the type of drive as follows:

• electric;

• pneumatic;

• manual;

• combined.

Depending on the operating conditions, there are mobile and stationary models. Mobile models are characterized by autonomy and are used in medical institutions and ambulances. Stationary models are connected to a centralized reservoir and operate from the clinic's power grid.

Key techniques, parameters of ventilation for newborns

The method for carrying out artificial ventilation depends on the disease, the degree of prematurity, the weight of the baby, the body's reaction to treatment. Specialists distinguish three main techniques: invasive, non-invasive, high-frequency.

Invasive or traditional ventilation is carried out in children through intubation in severe cases, when independent breathing is not possible. The doctor inserts an endotracheal tube through which the device delivers a mixture of oxygen and air under positive pressure. This process fills the lungs with oxygen and expels carbon dioxide. Invasive ventilation is aggressive and requires constant monitoring of oxygen and carbon dioxide levels. Specialists regulate the basic parameters: air pressure, breathing rate, and the ratio of gases in the supplied mixture. Conventional therapy is conducted using the following modes:

1. IPPV — intermittent positive pressure ventilation.

2. PCV — pressure controlled ventilation.

3. SIMV — synchronized intermittent mandatory.

4. VCV — volume controlled ventilation.

5. HFOV — high-frequency oscillatory.

Non-invasive artificial ventilation is used when the respiratory function of the newborn is impaired. This method involves supporting spontaneous breathing with a gentle influence on the respiratory organs. The oxygen mixture is supplied through special masks or cannulas. The device creates constant or periodic pressure, preventing the collapse of the alveoli, reducing hypoxia, and helping to maintain a normal level of carbon dioxide in the blood.

Non-invasive ventilation is performed in three modes: CPAP, NIPPV, BiPAP. CPAP — creates continuous positive pressure. NIPPV — generates intermittent positive pressure. BiPAP ventilation provides a two-level positive pressure sequence.

High-frequency ventilation is performed more often in conjunction with invasive ventilation. The method is designed to treat pulmonary pathologies, preventing tissue damage. The device provides a high frequency of breathing cycles with a small volume of air. Thanks to the technique, gas exchange occurs at the level of the alveoli without stretching the tissues. During high-frequency ventilator in children regulate the parameters: the number of respiratory cycles, average pressure, amplitude of oscillations, oxygen fraction. A special place is occupied by high-frequency artificial ventilation devices that generate combined and jet ventilation with a frequency of up to 60 cycles per minute. Due to strict compliance with pressure, humidification and heating systems, they prevent barotraumas, hypothermia, drying of the respiratory tract.

Choosing a ventilation system for the neonatal unit

When choosing an apparatus for ventilation in newborn babies, it is important to conduct a comprehensive analysis of the functional features and ease of use of the proposed models. Neonatal equipment should include standard automatic and spontaneous modes, as well as the key operational modes:

• periodic inflation of the lung cavity;

• trigger;

• forced;

• controlled;

• synchronized intermittent, mixing the oxygen mixture.

Multifunctional devices also feature an additional manual ventilation mode. The presence of specialized sensors alerts the operator to any pressure violations, temperature changes, or malfunctions. The backup ventilation function includes a built-in accumulator, ensuring continued power supply if the main source is disconnected.

Modern devices for ventilation in the neonatology department have a wide range of possibilities: a unique pneumatic effect, valve-free system, maintenance of a regular pressure wave, emergency shutdown if necessary, additional release of excess flow, the presence of an oxygen analyzer, gas filtration, modular design.

Tips for use and maintenance

Resuscitation and anesthesia equipment is important to keep in perfect working condition, especially in the neonatology department. TThe lives of young patients depend on the proper functioning of the equipment. To prevent malfunctions and breakdowns, regular maintenance is essential. The specifics of maintenance depend on the device model, and the operating guidelines are determined by the manufacturer. For each ventilator, the following items must be applied:

• cleaning of air circuits;

• calibration and check of valves;

• control of oxygen sensors;

• testing of autonomous power supply;

• replacement, cleaning of filters;

• cleaning of cooling fans;

• air circuit leak test;

• event log analysis;

• troubleshooting software errors;

• monitoring the compliance of inhalation and exhalation volumes.

It is important to regularly replace consumables. Service and repair by specialists guarantees the stability of medical equipment throughout the period of use.

Conclusion

Premature babies face numerous challenges in the first days of life. Often, their lungs are underdeveloped, requiring special care from medical specialists. To support these young patients, it is crucial to equip the medical facility with specialized artificial ventilation equipment. Before purchasing ventilator equipment, it's important to analyze the types and methods of use. Leading medical device manufacturers incorporate advanced technologies to create safe, highly accurate, durable, and user-friendly devices. Bimedis International Marketplace offers a wide range of resuscitation equipment, providing professional solutions for medical facilities.