Mechanical ventilation setting in Different clinical conditions and its follow up in children

The ventilatory strategy in mechonium aspiration is to intiate ventilation with low PEEP (4-5cm H2O) that help in splinting open partially obstructed airways and equalizing V/Q matching higher levels may lead to hyperinflation. If air way resistance is high and compliance is normal, a slow rate, moderate pressure strategy is needed. Brochopulmonary dysplasia results from injury to the alveoli and airways, the ventilator strategy is to wean infants off the ventilator as soon as possible to prevent further barotrauma and oxygen toxicity and ventilatory settings should be minimized and rates as low as 10 to 15 breaths/min should be avoided to prevent increased work of breathing, but longer TI (0.4 – 0.5) sec may be used to prevent increased work of breathing weaning of the baby on mechanical ventilation aims to allow the infant to assume gradual progressive responsibility for gas exchange while ventilatory support is decreased by decreasing pressure first to a low level <15 Cm H2o before decreasing the rate in SIMV weaning, thus reducing the barotraumas and late air leak. Mechanical ventilation can result n numerous adverse outcomes including Barotrauma / Volutrauma, resulting in in Branchopulmonary dysplasia and air leak and O2 toxicity that cause retinopathy of prematurity, so newer studies recommend lowering O2 saturation to reduce the incidence of ROP in the most susceptible infants without increasing neurologic dysdunction out comes.