The modern era of infant mechanical ventilation came about in 1953, but these were adult machines modified to try to meet the needs of the neonate. Increased chest wall compliance, terminal airway and alveolar collapse characterize neonatal pulmonary disease. Modified adult devices were usually not adequate to provide the needed support. These two concepts, along with other advances in design and technique, have given today's clinician many methods to ventilate the neonate. No definitive studies have been done to demonstrate the physiologic advantage of positive pressure vs. volume ventilators.
Clinicians base their choices on anecdotal experience and several theoretical considerations.
Because of the desirability of regulating spontaneous and mechanical ventilation, few of the many volume-limited ventilators available are truly useful in the ventilation of the neonate. It's become a proven and familiar therapy. Additionally, the complexity, increased expense in purchase price and maintenance of volume ventilators has contributed to their disappearance from the neonatal marketplace. Historically, positive pressure ventilators have been less costly and more exclusively utilized because of their simpler design and ease of operation. Regardless of the type of assisted ventilation chosen by the clinician, comprehensive knowledge and understanding of the normal pulmonary physiology, as well as the pathophysiology of pulmonary diseases of the neonate is required to utilize the device properly.