RESUMO
Volutrauma and pulmonary inflammation are thought to be the most important predisposing factors of chronic lung disease (CLD), a major complication of prematurity. A new option in patient-triggered ventilation (PTV), the volume guarantee (VG), a volume-targeted ventilation, seems to be a promising approach in reducing the risk of CLD, by limiting lung inflammatory injury and volutrauma. Our aim was to evaluate lung inflammatory response in preterm infants with respiratory distress syndrome (RDS), mechanically ventilated with and without VG, as measured by proinflammatory cytokines (IL-6, IL-8, and TNF-alpha) in tracheobronchial aspirate (TA) fluid. Fifty-three preterm infants (GA = 25-32 weeks) with RDS were randomized at birth to be ventilated using pressure support ventilation (PSV) with VG (Vt = 5 ml/kg) (n = 30) and without VG (n = 23) (Draeger Babylog 8000 Plus, 5.n). IL-6, IL-8, and TNF-alpha were determined by ELISA in TA samples on days 1, 3, and 7 of life. We observed a significant difference (ANOVA) in IL-8 and IL-6 levels on day 3 between the two groups (P < 0.05), and an increasing significative trend in IL-8 values in PSV group (P < 0.05). Mechanical ventilation lasted longer in the PSV group (12.3 +/- 3 vs. 8.8 +/- 3 days) (P = no significance). In conclusion, these preliminary data suggest a role for volume-targeted ventilatory strategy in reducing acute inflammatory response in preterm infants with RDS. Further studies are required in order to define whether this ventilatory strategy prevents lung injury.
Assuntos
Recém-Nascido Prematuro , Inflamação , Pulmão/imunologia , Pulmão/patologia , Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Citocinas/análise , Feminino , Humanos , Recém-Nascido , Inflamação/etiologia , Inflamação/prevenção & controle , MasculinoAssuntos
Proteínas de Transporte/efeitos dos fármacos , Hipertensão Pulmonar/tratamento farmacológico , Peptídeos e Proteínas de Sinalização Intracelular/efeitos dos fármacos , Neonatologia , Piperazinas/uso terapêutico , Sulfonas/uso terapêutico , Vasodilatadores/uso terapêutico , Administração por Inalação , Administração Oral , Broncodilatadores/administração & dosagem , Proteínas de Transporte/metabolismo , Endotélio Vascular/efeitos dos fármacos , Humanos , Hipertensão Pulmonar/metabolismo , Hipertensão Pulmonar/fisiopatologia , Recém-Nascido , Injeções Intravenosas , Peptídeos e Proteínas de Sinalização Intracelular/metabolismo , Óxido Nítrico/administração & dosagem , Piperazinas/administração & dosagem , Piperazinas/farmacologia , Purinas/administração & dosagem , Purinas/farmacologia , Purinas/uso terapêutico , Citrato de Sildenafila , Sulfonas/administração & dosagem , Sulfonas/farmacologia , Resultado do Tratamento , Vasodilatadores/administração & dosagem , Vasodilatadores/farmacologiaRESUMO
Laryngeal atresia is a rare congenital cause of high airway obstruction that can lead to death if not correctly recognized and treated at birth. Postnatal management is difficult and the prognosis is often poor. We report a case of prenatal diagnosis of laryngeal atresia in a fetus that was delivered preterm at 29 weeks of gestation. Tracheotomy was performed as an ex utero intrapartum treatment (EXIT) to guarantee patent airway, and laryngotracheoplasty was performed at 22 months of corrected age. A favorable ventilatory and neurodevelopmental outcome was observed at 33 months of age.