The “breath of life” is a narrative weaving throughout many cultures, signifying the beginning of humanity. Across nearly all known lifeforms, oxygen is essential for survival. When a newborn human enters the world, their first significant action is to breathe. However, the lungs of a neonate are delicate and there are many reasons one may struggle to breathe independently. Relative to other mammals, humans are born with underdeveloped lungs, which is of particular concern in cases of prematurity and can lead to acute respiratory distress syndrome (ARDS). Birth complications or abnormalities may also result in ARDS. Respiratory issues can cause permanent injury and are one of the leading causes of infant mortality. However, rates of infant mortality have drastically decreased with the continued development of mechanical ventilation (MV).

MV is a respiratory therapy where a ventilator takes over some, or all, work of breathing. MV maintains oxygenation when a patient is unable to do so independently, such as during respiratory distress or sedation. It is an essential therapy in the intensive care unit (ICU) and the neonatal intensive care unit (NICU).

Current MV approaches administer a positive pressure of air at the airway via a mask, nasal prongs, or invasive intubation. There are many modes and settings which are chosen by the clinicians. Modes range from non-invasive and patient driven, to invasive and fully automated. Once the mode of ventilation is chosen, settings may include: driving pressure; positive end-expiratory pressure; tidal volume inspired per breath; rate of air flow; inspiratory and expiratory time; percentage of oxygen delivered; trigger sensitivity; and fraction of inspired oxygen. Ideal MV mode and settings are dependent on the individual patient’s needs. Suboptimal settings can result in inadequate oxygenation, ventilator-induced lung injury (VILI)and sustained need for MV, ultimately conflicting with MV goals and patient wellbeing.