BMET RESOURCE FILE

A Quick View . . .

Neonatal Vs. Adult Ventilation

Brian Glynn BS, RRT

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O
n most mechanical ventilators, the first control
that an operator must determine for use on a
patient is the mode of ventilation. Modes are
basically types of breaths that the ventilator will deliver.
Present day ventilators have volume modes and pressure
modes.
Volume modes deliver a preset volume to the patient
and pressure modes deliver a preset pressure to the
patient. For years, volume ventilation was preferred on
adults and pressure ventilation was preferred on
neonates.
Over the last decade, however, pressure ventilation
has become increasingly popular in the adult population,
which leads to the question: What’s the difference
between pressure ventilation in neonates and adults?
This has become an increasingly thin line as pressure
control has found favor in adult ventilation.
All ventilator strategies seek to minimize barotraumas
and optimize gas exchange. In addition to utilizing lower
patient circuit pressures and smaller volumes, neonatal
pressure ventilators have other distinguishing character-
istics that allow practitioners to ventilate neonates more
V.I.P. Bird® Gold Infant/Pediatric ventilator.
safely. (This should not be confused with such neonatal
ventilator technologies as the High Frequency
Oscillator and Jet Ventilator, which differ greatly from mass, neonatal ventilators such as the Bird V.I.P. Gold
pressure ventilators in design and principle.) use a proximal flow sensor to allow for flow triggering
To compare neonatal and adult ventilators, we exam- and volume measurement. The location of the sensor
ine the 3 stages of the mechanical breath: (1) initiation of (close to the patient) reduces the work of breathing for
breath, (2) flow pattern of breath, and (3) termination of the patient. Another neonatal ventilator, The Bear Cub
breath. 750, also utilizes a flow sensor at the proximal airway.
While adult ventilators such as the Bear 1000 may
Initiation of Breath also utilize an inspiratory flow transducer to sense
A ventilator in assist mode can deliver a breath to a patient effort, the transducer is not as close to the
patient when it senses inspiratory effort. Ventilators use patient. The Puritan-Bennett Mallinckrodt 840 adult
pressure or flow sensors in the patient circuit to sense ventilator initiates breaths based on the monitored pres-
this effort. Since neonates tend to sure at 2 locations: inspiratory pressure is monitored
have less energy reserve and muscle inside the inspiratory manifold and expiratory pressure
is monitored just after expiratory check valve. The expi-
ratory pressure is used to signal the beginning of the next
Brian Glynn, BS RRT, is Clinical
inspiration. Both of these adult ventilators offer the
Supervisor of Respiratory Care at Thomas
Jefferson University Hospital in option of having the inspiratory effort measured in
Philadelphia, PA. either flow or pressure.

Biomedical Instrumentation & Technology 127

BMET RESOURCE FILE
Neonatal Vs. Adult Ventilation

Flow Pattern of Breath

The gas flow pattern in pressure ventilation for adults is
determined by the amount of pressure that is preset and
the compliance and resistance of the lungs. In pressure
cycled ventilation for neonates, the inspiratory gas flow
is preset by the operator in order to minimize lung dam-

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age from too much flow.

Termination of Breath
Mechanical ventilators in pressure mode for both
neonates and adults terminate machine breaths when a
preset inspiratory time is met. Neonatal ventilators such
as the V.I.P. Gold have a feature called termination sensi-
tivity which enables the practitioner to terminate a
breath when a percentage of the flow is reached. The
benefit is that this feature limits the amount of time the Bear Cub 750 proximal airway flow sensor, shown in a
lung is pressurized, therefore reducing damage to the patient circuit diagram.
lung. In summary, neonatal and adult pressure ventila-
tion techniques now have relatively subtle differences.

Bibliography
Branson RD, Chatburn RL. Technical description and classifica-
tion of modes of ventilator operation. Respir Care 37:
1026–1044,1992.
Kacmarek RM, Hess D. Basic principles of ventilator machinery.
In Tobin MJ: Principles and Practice of Mechanical Ventilation.
New York, Mcgraw-Hill, 1994.

Ventilators More Reliable

With Greater Use, Study Finds

W hile the reliability of a mechanical ventilator

is dependent on many factors, the unit
improves the more it is used, according to research
findings outlined in Respiratory Care Journal.
The study also found a connection between
improved reliability and the amount of time a par-
ticular brand of ventilator has been commercially
available.
The study, which analyzed 66 ventilators operat-
ed at 2 hospitals between July 1991 and January
2001, was intended to measure the effect of repairs
on ventilators. It found that the amount of times a
ventilator had been repaired had no impact on a
unit’s reliability, while the hospital’s environment
had a significant effect on reliability.
To learn more about this study, a summary can
be accessed online at www.rcjournal.com/contents/
08.01/08.01.0789.html.

128 January/February 2002