ABSTRACT
Hypoxic respiratory failure (HRF) may occur in a variety of neonatal respiratory disorders. A firm understanding of the underlying lung pathophysiology, and how it may change over time, is necessary to optimally apply invasive mechanical ventilation in the neonate. Although a variety of ventilatory modes are available, there is limited evidence to strongly support one mode or approach over another for most conditions. It is critical to recognize that the lungs of all newborns are not developmentally complete (not just the most premature) and may be more susceptible to VILI. Key to successful intervention for HRF is optimizing overall lung inflation, regardless of the ventilator mode employed. Clinical approaches to optimize lung inflation and their limitations are described in the following chapter. We briefly review common neonatal disorders associated with HRF as well as the two main ventilatory approaches, high frequency and conventional modes, used in the management of neonatal HRF. We emphasize that most important factor associated with safe and successful ventilator management of the sick neonate is the person operating the ventilator rather than the ventilator itself.
