The intensive neonatal care is a highly dependent on technical progress and advanced apparatus to treat the youngest, sickest patients. The trend identified is to develop more and more integrated systems, where large actors on the market have spent the past years developing ventilators with multiple functions. However, taking one step back, the intensive care is initiated way before the baby is connected to a ventilator. Right after the baby is born, a manual, life saving resuscitation procedure can be carried out, for which there is a lack of tools to evaluate how effective the treatment really is.
The ventilation is the most crucial part of this resuscitation procedure. An optimal tidal volume is required to avoid both underventilation, causing inadequate gas exchange, and overdistension of the lungs, playing a key role in the development of lung injuries such as bronchopulmonary dysplasia, BPD, which affect preterm babies in particular.
Animal studies have shown that just a few excessive manual ventilations are enough to start the process leading to lung injuries and other organ damage, and that it is high volumes (Volutrauma) rather than high pressures, that mainly causes this effect. In addition to this, the founders of Monivent® have conducted a study showing that lung mechanics change very rapidly during the first minutes after birth, while resuscitation is performed. If a constant pressure is then given that will result in increasing tidal volumes as the lung mechanics change.
While a baby is connected to a ventilator in the neonatal intensive care unit, a gentle approach is taken to provide a proactive ventilation treatment with controlled levels of provided volume. However the same gentle approach needs to be taken in the delivery room during the very first minutes of ventilation.
This strongly support that volume targeted ventilation shall be applied in the manual ventilation performed during resuscitation.