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Lung injury remains an important cause of morbidity among newborns who require assisted ventilation. Studies in immature animal models of respiratory distress syndrome(RDS) have shown that positive-pressure ventilation with large tidal volumes damages pulmonary capillary endothelium, alveolar and airway epithelium, and basement membranes. This mechanical damage results in leakage of fluid, protein,and blood into the airways, alveoli,and interstitial spaces, leading to inhibition of surfactant activity and further injury to the lung. Cyclic changes in lung volume appear to be more important than changes in airway pressure in causing this damage, suggesting that a ventilator strategy that avoids large changes in lung volume may reduce lung injury. Consequently, considerable interest has been generated over the past 15 years in the application of high-frequency ventilation (HFV) in newborns who have respiratory failure because this technique allows ventilation with very small tidal volumes.

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