Ventilating the newborn and child

The mechanical ventilation of neonates and children in operating theatres has always posed a challenge for anaesthesiologists. Firstly, the extreme physiological features of neonatal lungs make them very difficult to ventilate with an anaesthesia ventilator. Gattinoni’s “baby lung” concept to describe ARDS lungs in adults comes from the physiological features of neonatal lungs (low dynamic compliance, low pulmonary time constant, low FRC, high closing volume, proneness to atelectasis, high inspiratory airway resistance). Secondly, the performance and technology (peak flow, insufflation power, trigger sensitivity, ventilation modes, etc.) of anaesthesia ventilators is still less advanced than those of critical care ventilators. It is possible to ventilate a normal healthy adult lung with an anaesthesia ventilator, but even today, using circle circuits, ventilating a premature baby, newborn or child in the operating theatre can be a real challenge. Over the last 5 years, great changes have been made to anaesthesia workstations, which now boast better mechanical ventilation performance for children as well as new ventilation modes. However, there is a lack of background knowledge regarding mechanical ventilation in operating theatres, and this limits the advantages that can be derived from this new technology, and thus any potential safety improvements in paediatric surgery.