Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study.

BACKGROUND: Lung recruitment at birth has been advocated as an effective method of improving the respiratory transition at birth. Sustained inflations (SI) and dynamic positive end-expiratory pressure (PEEP) were assessed in clinical and animal studies to define the optimal level. Our working hypothesis was that very low gestational age infants (VLGAI) < 32 weeks' gestation require an individualized lung recruitment based on combining both manoeuvers. METHODS: Between 2014 and 2016, 91 and 72 inborn VLGAI, requiring a respiratory support beyond a continuous positive airway pressure (CPAP) = 5 cmH2O, were enrolled before and after introducing these manoeuvers based on progressive increase in SI up to 15 s, with simultaneous gradual increase in PEEP up to 15 cmH2O, according to the cardiorespiratory response. Retrospective comparisons of the incidence of mechanical ventilation (MV) < 72 h of life, short-term and before discharge morbidity were then performed. RESULTS: Among extremely low gestational age infants (ELGAI) < 29 weeks' gestation, the following outcomes decreased significantly: intubation (90 to 55%) and surfactant administration (54 to 12%) in the delivery room, MV (92 to 71%) and its mean duration < 72 h of life (45 h to 13 h), administration of a 2nd dose of surfactant (35 to 12%) and postnatal corticosteroids (52 to 19%), and the rate of bronchopulmonary dysplasia (23 to 5%). Among VLGAI, all of these results were also significant. Neonatal mortality and morbidity were not different. CONCLUSIONS: In our setting, combining two individualized lung recruitment maneuvers at birth was feasible and may be beneficial on short-term and before discharge pulmonary outcomes. A randomized controlled trial is needed to confirm these results.

[Palliative care in Lebanon: views of health professionals and relatives]. / Soins palliatifs au Liban: Avis des soignants et des proches.

CONTEXT: The development of palliative care is still in its primitive state in Lebanon and few studies assessed the views of caregivers on the quality of support of their patients and the difficulties they encounter. We evaluate the perspective of caregivers and the relatives in regard to the quality of support to the terminally ill patients. METHOD: A cross-sectional descriptive, analytic and comparative study is carried out between September and October 2010, among two groups - Group 1: Health professionals from a university hospital in Beirut; Group 2 : Relatives of recently deceased persons following a chronic, incurable disease. RESULTS: We received 447 responses: 358 in the hospital from caregivers (80%) and 89 in the city from relatives (20%). The management of physical problems of patients at end of life is considered adequate by 68% of caregivers while only 40% believe that psychological problems are managed adequatly. Physical difficulties most often encountered are intractable pain (44%) ; psychological problems frequently noted at this stage are depression (40%), anxiety (18%) and fear of death (115%). Caregivers (69%) and relatives (62%) are in favor of informing the patient about the seriousness of his illness; and physicians more frequently than nurses (75% vs 675%, p = 0.002). Relatives (75%) and caregivers (73%) believe that today in Lebanon, the terminally ill patients do not die in peace and dignity (p = 0.022). 71% of caregivers vs 62% of relatives consider that intensive medications are used in cancer patients (p < 0.001) and non-cancer patients (61% caregivers vs 60% of relatives; p > 0.05). CONCLUSION: The management of terminally ill patients and their families must be improved. Palliative care services adapted to the cultural, social and economic characteristics of the country, and involving the private and public sectors should be integrated into the current health system.