Neonatal Pulmonary Graphics: A Clinical Pocket Atlas 2015 Edition by Donn, Steven, Mammel, Mark C. (2014) Taschenbuch

We have witnessed tremendous technological advances since the first neonatal patients were mechanically ventilated in the late 1960s using modifications of devices built for adults. Even after the advent of infant-specific ventilators, patient assessment was rudimentary, consisting of the clinical examination and the occasional chest radiograph and blood gas analysis.
A key concept was missing in this initial approach. The mechanical ventilator at that time worked best with a passive subject. However, unless pharmacological paralysis was used (which it often was), the spontaneously breathing infant was anything but passive, trying to breathe while the ventilator tried to assist, but seldom at the same time. The concept of patient–ventilator interaction was born. Firstgeneration equipment to measure pulmonary mechanics appeared in the late 1970s but was cumbersome, difficult to calibrate, and often gave unreliable or irreproducible data. The introduction of the microprocessor in the 1980s was a giant leap forward, enabling breath-to-breath bedside assessment of the baby and the ventilator for the first time. This included measurements and displays of valuable information about lung mechanics, patient–ventilator synchrony, and the response to different ventilation strategies and pharmacological interventions. Ventilation of the neonatal patient finally moved from “one size fits all” to customized strategies based on the underlying pathophysiology and the baby’s response to intervention.