pHred

A common and significant problem is the actual delivered dosage. There are too many variables to effectively standardize treatment.

A seminal issue that should be revisited every two or three years due to technological evolution. The advent of AI support and the artificial womb will undoubtedly change the pro/con arguments.

Until the role of manual device rescue ventilation in the development of BPD is quantified and qualified, progress in treatment will continue to be elusive

Anchoring tubing can be a hazard. When the infant’s head is elevated (as in GERD care), the baby can slide down the mattress and increase pressure on the septum. Occurs most often at night. Tubing should be free to move with the infant.

Agree that 6 hz is too slow. Appropriate MAP is key to successfully ventilating and oxygenating. Axiom #1: The best ventilator is the one you have the most expertise with. New (to the user) forms of ventilation open the door for errors of inexperience. Axiom #2: HFOV has a checkered past in many studies. Sun et al demonstrated strongly positive results in VLBW infants receiving HFOV vs pressure support ventilation. Why the discrepancy? Consider the adjunct care. Hypothesis: Whenever an infant is disconnected from an oscillating device, the lungs instantly deflate. Consider that extremely premature infants have little, if any, alveolar surface area.Temporary ventilation is usually provided by a manual resuscitation device that cannot match the oscillator. This act in itself likely contributes to barotrauma and subsequent CLD. Terminal bronchioles are “bubbled up” by attempts to mimic the ventilation we see in term infants. Evidence includes the observation that it can take a half hour after reconnecting the infant to HFOV to fully achieve reinflation. Thus, any interruption in oscillatory MAP can be considered iatrogenic. Axiom#3: The role of manual resuscitation in the development of CLD has not been adequately studied (almost completely ignored). Disconnection from high MAP ventilation is rarely a point of focus. These omissions skew most of the observations and conclusions in neonatal ventilation studies. ref: Sun et al ClinicalTrials.govNCT01496508 Respiratory Care Feb 2014, 59(2) 159- 169