ABSTRACT
Mechanical ventilation is considered to be one of the most important of the many putative etiologic factors in bronchopulmonary dysplasia (BPD). Is this blame justified, and if so, what is the rationale for the various ventilatory strategies that have been proposed to minimize lung injury? There has been much research, as well as speculation, on the optimal means of mechanical ventilation. The quest for a noninjurious mode of ventilatory support continues. Current innovations include permissive hypercapnia, avoidance of mechanical ventilation, ‘‘gentler’’ respirators (e.g., high-frequency oscillation), and various forms of noninvasive ventilation. Improvement in gas exchange was once the single major goal of mechanical ventilation, whether the cause of respiratory failure was neuromuscular or pulmonary. As this goal has become more easily obtainable with adjunctive treatment, such as exogenous surfactant, the focus has been on obtaining acceptable gas exchange with the least possible amount of inspired oxygen and applied pressure. Several chapters in this volume address various aspects of the causal relation of mechanical ventilation to BPD; the pathology of ‘‘barotrauma’’; the role of different mechanical ventilatory patterns; lung injury from overexpansion; and the effects of various respiratory care practices on BPD. Until there is more
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clear-cut evidence of a decidedly superior respirator or pattern of ventilation, various strategies will continue to be proposed and championed.
