What is the recommended management for neonates with wet lung (transient tachypnea of the newborn) requiring ventilation?

From the Guidelines

The recommended management for neonates with wet lung (transient tachypnea of the newborn) requiring ventilation involves the use of positive end-expiratory pressure (PEEP) at approximately 5 cm H2O, as suggested by the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1. When administering positive pressure ventilation (PPV) to preterm newborns, the addition of PEEP may help reduce the need for supplementary oxygen, although the evidence is low-quality and the studies were underpowered to confirm a significant difference. Key aspects of management include:

• Use of a flow-inflating or self-inflating resuscitation bag or T-piece resuscitator for PPV
• Administration of PEEP at approximately 5 cm H2O, which may require the addition of a PEEP valve for self-inflating bags
• Gentle ventilation strategies with low tidal volumes and moderate PEEP to support oxygenation while minimizing lung injury
• Maintenance of adequate oxygen saturation levels, typically between 90-95% The goal of management is to support the neonate's respiratory system while the condition resolves spontaneously, usually within 24-72 hours, as the pulmonary fluid is absorbed.

From the Research

Recommended Management for Neonates with Wet Lung Requiring Ventilation

The management of neonates with wet lung, also known as transient tachypnea of the newborn, requiring ventilation involves several strategies to minimize lung injury and promote optimal respiratory support. Some key considerations include:

• The use of gentle ventilation approaches to avoid short- and long-term problems associated with mechanical ventilation, such as ventilator-associated lung injury (VALI) and ventilator-associated pneumonia (VAP) 2.
• The application of volume ventilation in infants, synchrony, and improving patient-ventilator interaction using techniques like neurally adjusted ventilatory assist (NAVA) 2.
• The utilization of noninvasive ventilation techniques, which have gained momentum in the era of gentle ventilation and open lung strategy 3.

Ventilation Modalities and Strategies

Various ventilation modalities and strategies can be employed to support neonates with wet lung, including:

• Conventional mechanical ventilation (CMV) modalities that aim to provide lung-protective ventilation strategies 4.
• Noninvasive respiratory support modalities, such as continuous positive airway pressure (CPAP), which has been proven to be an effective mode of ventilatory support in neonates 3.
• The use of CPAP adjuncts, such as nasal intermittent positive pressure ventilation (NIPPV) and infant flow driver, which can also be beneficial in certain cases 3.

Lung-Protective Strategies

To minimize the risk of ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD) in neonates, lung-protective strategies are essential. These strategies include:

• The use of protective and open-lung ventilation strategies, which aim to ventilate the lungs with minimal damage 5.
• The application of real-time pulmonary monitoring to continuously adapt the ventilation strategy to the sudden changes in the respiratory mechanical properties of the lung 5.
• The implementation of evidence-based concepts and lung-protective strategies to guide clinicians in preventing and attenuating VILI and BPD in neonates 6.