Respiratory well-being is a critical factor among newborns and infants. During early development stages, it is not uncommon to find that babies experience some issues with their breathing and other functions of the respiratory system. Studies show that respiratory distress is especially common, particularly when looking at newborn babies. In these situations, management of the condition will often involve the use of ventilation. Some scenarios do call for pediatric mechanical ventilation, which we will discuss in this article.
What Is Mechanical Ventilation?
Mechanical ventilation is a treatment generally used in a hospitalized setting. These techniques are considered highly effective in scenarios where a patient experiences breathing difficulties. This may include scenarios where breathing is not possible and cases where the patient is unable to breathe normally on their own. There are different types of mechanical ventilation methods that can be used. The specific options utilized for a patient largely depend on their current condition and the reason for using the mechanism as a treatment option.
Noninvasive Ventilation
The more common option to be used include noninvasive ventilation. This particular technique does not include the use of any invasive procedures. It is used in hospitalized situations but can sometimes provide an efficient treatment mechanism at the patient’s home. These mechanisms are commonly used for some of the milder respiratory problems patients may experience. Research shows that using these noninvasive ventilation mechanisms can provide an efficient option for at-home treatment. In a particular study, the researchers found improvements in PaCO2. There were also improvements in exercise tolerance among individuals who had been diagnosed with chronic hypercapnic COPD.
Common types of noninvasive ventilation include:
● CPAP: This mechanism is also known as continuous positive airway pressure. It is used when the patient requires a consistent supply of air pressure to their lungs to provide a breathing aid.
● APAP: An auto-titrating positive airway pressure system can be adjusted to better comply with the patient’s breathing. These are adjustable devices that sometimes work automatically. The goal is for the provisioning of air to the lungs to match the patient’s breathing patterns.
● BiPAP: These mechanisms are called bilevel positive airway pressure devices. They offer two different levels of pressure. One level is used for inhaling air and another for exhalation.
Invasive Ventilation
A more invasive ventilation mechanism may be used in cases where the patient has a severe condition affecting their respiratory system. Invasive ventilation procedures are often seen among patients admitted to an intensive care unit. In this particular scenario, a pipe is placed in the patient’s airways down toward the lungs. The goal here is to provide a more efficient air reach into the lungs. Many people who receive invasive ventilation will be unable to breathe independently.
There are two common procedures utilized for invasive ventilation, including:
● Tracheostomy: In this case, a hole is made in the patient’s airway from the outside. A tube is then placed into this hole to reach the lungs.
● Endotracheal intubation: This procedure does not require a hole to be made in the airway. Instead, a tube is placed into either the nose or the mouth. The tube is then run toward the airway, where it can reach the lungs.
How Does Pediatric Mechanical Ventilation Work?
Mechanical ventilation is a technique reserved for adults and serves as an effective breathing aid for newborns, infants, and toddlers. The procedure will be referred to as pediatric mechanical ventilation in these situations. In these particular scenarios, careful monitoring is needed, and the specialist will need to consider all currently available options.
Both endotracheal intubation and tracheostomy methods can be used for pediatric mechanical ventilation. It should be noted that in many cases, a noninvasive ventilation procedure is utilized initially to assist with breathing. Specialists will monitor the progression and recovery, then decide whether an invasive intubation procedure is needed to provide more efficient treatment. The use of invasive ventilation options is also more common among infants admitted to an intensive care unit.
During the 2017 Paediatric Mechanical Ventilation Consensus Conference, also referred to as the PEMVECC, recommendations were made for using these mechanisms on newborns and infants. A total of 152 recommendations were made, with a priority for providing efficient treatment while also taking the safety of the pediatric patient into account. Additional recommendations were made for mixed diseases where the respiratory system was involved and scenarios where the infant is affected by certain cardiac problems.
The Pediatric Acute Lung Injury Consensus Conference also made numerous suggestions to optimize mechanical ventilation among younger patients. During the conference, it was noted that data is still lacking in some departments, which calls for further research to be implemented.
Conditions That Require Pediatric Mechanical Ventilation
Numerous conditions may require the use of pediatric mechanical ventilation, with a particular focus on diseases that affect the respiratory system. There are also some situations where nonpulmonary conditions may require this type of mechanism throughout the treatment procedure.
Research suggests that the most common reason for mechanical ventilation to be used among pediatric patients is respiratory distress. In newborns, the cause behind related symptoms is often linked to neonatal respiratory distress syndrome. This is often observed among preterm neonates. It can, however, affect term infants as well.
Ventilation support has been suggested as a recommended treatment for newborns experiencing acute respiratory distress. Studies also advise that using these ventilation mechanisms may yield an effective treatment option in scenarios where a newborn shows signs of an acute lung injury. While this is a rare occurrence in infants, there is a concern regarding the mortality rate. One study also suggested that this particular support mechanism may become helpful in cases where infants suffer an acute brain injury. This study suggests that the process of utilizing the treatment for this scenario yields risks. Still, specialists are advised to weigh the benefits compared to complications when mechanical ventilation is not used in the process. Positive end-expiratory pressure is the suggested method of mechanical ventilation for these scenarios.
Conclusion
Pediatric mechanical ventilation is relatively common among newborns who experience respiratory distress and related conditions. The ventilation method can assist with breathing while additional treatments are implemented to help the infant recover from a specific disease. These devices use a mechanical mechanism to push air into the patient’s lungs, which assists with the breathing process. Different mechanical ventilation techniques exist, so the average parent must understand the differences and note how each would help their infant.
