RESUMEN
OBJECTIVE: Delivery room (DR) management may play an important role in the development and prevention of lung injury. Therefore, in a cohort of low birth weight infants (LBW), we investigated the effects of two different lung recruitment maneuvers, such as positive pressure ventilation (PPV) and sustained inflation (SI) on adrenomedullin (AM), a well-established lung-specific vasoactive agent. STUDY DESIGN: This is a prospective case-control randomized study in 44 LBW infants spontaneously breathing with respiratory failure at birth requiring respiratory support. LBW were randomized to receive PPV (n = 22) or SI (n = 22) support. AM was measured from blood in samples collected at birth from arterial artery (BLT0) and at 1-hour (BLT1) and at 24-hour (BLT2) from peripheral venous site. AM assessment in urine samples was performed at 1-hour (URT1) and at 24-hour (URT2). RESULTS: No significant differences in AM (p > 0.05) blood (T0-T2) and urine (T1, T2) levels were observed between groups. CONCLUSION: The present data, showing the absence of any differences in AM blood and urine levels, suggest that PPV and SI are both feasible and equally effective DR maneuvers. The findings open the way to further studies evaluating the effects of PPV and SI on short-/long-term respiratory outcome through biomarkers assessment.
Asunto(s)
Adrenomedulina/sangre , Adrenomedulina/orina , Presión de las Vías Aéreas Positiva Contínua , Recién Nacido de Bajo Peso/sangre , Respiración con Presión Positiva , Insuficiencia Respiratoria/terapia , Biomarcadores/sangre , Biomarcadores/orina , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido de Bajo Peso/orina , Recién Nacido , Recien Nacido Prematuro/sangre , Recien Nacido Prematuro/orina , Masculino , Estudios Prospectivos , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Insuficiencia Respiratoria/sangre , Insuficiencia Respiratoria/orinaRESUMEN
Hypothermia is used for its neuroprotective effect in perinatal asphyxia. Mechanical ventilation is often used as a supportive therapy for severe asphyxiated infants who can present various degrees of respiratory failure. Animal studies demonstrated a protective effect of cooling on the lungs due to reduced ventilatory requirements. Even if actual knowledge on the effects of hypothermia and rewarming on respiratory parameters during mechanical ventilation is limited, nevertheless human studies seem to demonstrate that hypothermia is safe and does not cause significant changes in the level of respiratory supports.
