Intermittent Mandatory Ventilation (IMV) in neonates leads to respiratory asynchrony and inefficient gas exchange. This can result in increased incidence of air leaks, fluctuation in blood pressure and cerebral blood flow irregularities leading to intraventricular haemorrhage (IVH). Efforts have been made to synchronize the ventilator breath with baby's inspiration, i.e. Patient Triggered Ventilation (PTV). A good trigger sensor is the most critical part for PTV success. Various trigger sensors have been devised based on their ability to detect changes in neonate's abdominal wall movement, thoracic impedance, airway pressure and air flow volume drop. Sensors which can detect minute changes in airway flow volume are the most recent ones. They are able to synchronize ventilator breath with neonate's inspiration as well as expiration. Simultaneously, they are also able to measure and calculate the complex dynamic respiratory volumes like compliance, resistance, tidal volume and minute volume. Various newer modes of ventilation have been devised using these calculations to make the mechanical breaths more close to physiological breaths. Patient triggered ventilation has been found to decrease the duration of ventilation but it does not decrease the death rate, incidence of Broncho pulmoary dysplasia (BPD) or intraventricular hemorrhage (IVH) as compared to IMV.
patient triggered ventilation, synchronised intermittent mandatory ventilation, pressure support ventilation
