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1.
Trials ; 22(1): 392, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127040

RESUMO

BACKGROUND: Non-invasive ventilation (NIV) has been recommended as the best respiratory support for preterm infants with respiratory distress syndrome (RDS). However, the best NIV technique to be used as first intention in RDS management has not yet been established. Nasal intermittent positive pressure ventilation (NIPPV) may be synchronized (SNIPPV) or non-synchronized to the infant's breathing efforts. The aim of the study is to evaluate the short-term effects of SNIPPV vs. NIPPV on the cardiorespiratory events, trying to identify the best ventilation modality for preterm infants at their first approach to NIV ventilation support. METHODS: An unmasked randomized crossover study with three treatment phases was designed. All newborn infants < 32 weeks of gestational age with RDS needing NIV ventilation as first intention or after extubation will be consecutively enrolled in the study and randomized to the NIPPV or SNIPPV arm. After stabilization, enrolled patients will be alternatively ventilated with two different techniques for two time frames of 4 h each. NIPPV and SNIPPV will be administered with the same ventilator and the same interface, maintaining continuous assisted ventilation without patient discomfort. During the whole duration of the study, the patient's cardiorespiratory data and data from the ventilator will be simultaneously recorded using a polygraph connected to a computer. The primary outcome is the frequency of episodes of oxygen desaturation. Secondary outcomes are the number of the cardiorespiratory events, FiO2 necessity, newborn pain score evaluation, synchronization index, and thoracoabdominal asynchrony. The calculated sample size was of 30 patients. DISCUSSION: It is known that NIPPV produces a percentage of ineffective acts due to asynchronies between the ventilator and the infant's breaths. On the other hand, an ineffective synchronization could increase work of breathing. Our hypothesis is that an efficient synchronization could reduce the respiratory work and increase the volume per minute exchanged without interfering with the natural respiratory rhythm of the patient with RDS. The results of this study will allow us to evaluate the effectiveness of the synchronization, demonstrating whether SNIPPV is the most effective non-invasive ventilation mode in preterm infants with RDS at their first approach to NIV ventilation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03289936 . Registered on September 21, 2017.


Assuntos
Ventilação com Pressão Positiva Intermitente , Síndrome do Desconforto Respiratório do Recém-Nascido , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Respiração com Pressão Positiva , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
2.
J Int Med Res ; 49(2): 300060520984915, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33641473

RESUMO

OBJECTIVE: To investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants. METHODS: This was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks' gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups. RESULTS: A total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group. CONCLUSION: As post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.


Assuntos
Ventilação com Pressão Positiva Intermitente , Ventilação não Invasiva , Extubação , Pressão Positiva Contínua nas Vias Aéreas , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro
3.
Cochrane Database Syst Rev ; 2: CD011878, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33543473

RESUMO

BACKGROUND: Transient tachypnea of the newborn is characterized by tachypnea and signs of respiratory distress. Transient tachypnea typically appears within the first two hours of life in term and late preterm newborns. Although transient tachypnea of the newborn is usually a self-limited condition, it is associated with wheezing syndromes in late childhood. The rationale for the use of salbutamol (albuterol) for transient tachypnea of the newborn is based on studies showing that ß-agonists can accelerate the rate of alveolar fluid clearance. This review was originally published in 2016 and updated in 2020. OBJECTIVES: To assess whether salbutamol compared to placebo, no treatment or any other drugs administered to treat transient tachypnea of the newborn, is effective and safe for infants born at 34 weeks' gestational age with this diagnosis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2020, Issue 4) in the Cochrane Library; PubMed (1996 to April 2020), Embase (1980 to April 2020); and CINAHL (1982 to April 2020). We applied no language restrictions. We searched the abstracts of the major congresses in the field (Perinatal Society of Australia New Zealand and Pediatric Academic Societies) from 2000 to 2020 and clinical trial registries. SELECTION CRITERIA: Randomized controlled trials, quasi-randomized controlled trials and cluster trials comparing salbutamol versus placebo or no treatment or any other drugs administered to infants born at 34 weeks' gestational age or more and less than three days of age with transient tachypnea of the newborn. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology for data collection and analysis. The primary outcomes considered in this review were duration of oxygen therapy, need for continuous positive airway pressure and need for mechanical ventilation. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: Seven trials, which included 498 infants, met the inclusion criteria. All trials compared a nebulized dose of salbutamol with normal saline. Four studies used one single dose of salbutamol; in two studies, three to four doses were provided; in one study, additional doses were administered if needed. The certainty of the evidence was low for duration of hospital stay and very low for the other outcomes. Among the primary outcomes of this review, four trials (338 infants) reported the duration of oxygen therapy, (mean difference (MD) -19.24 hours, 95% confidence interval (CI) -23.76 to -14.72); one trial (46 infants) reported the need for continuous positive airway pressure (risk ratio (RR) 0.73, 95% CI 0.38 to 1.39; risk difference (RD) -0.15, 95% CI -0.45 to 0.16), and three trials (254 infants) reported the need for mechanical ventilation (RR 0.60, 95% CI 0.13 to 2.86; RD -0.01, 95% CI -0.05 to 0.03). Both duration of hospital stay (4 trials; 338 infants) and duration of respiratory support (2 trials, 228 infants) were shorter in the salbutamol group (MD -1.48, 95% CI -1.8 to -1.16; MD -9.24, 95% CI -14.24 to -4.23, respectively). One trial (80 infants) reported duration of mechanical ventilation and pneumothorax but data could not be extracted due to the reporting of these outcomes (type of units of effect measure and unclear number of events, respectively). Five trials are ongoing. AUTHORS' CONCLUSIONS: There was limited evidence to establish the benefits and harms of salbutamol in the management of transient tachypnea of the newborn. We are uncertain whether salbutamol administration reduces the duration of oxygen therapy, duration of tachypnea, need for continuous positive airway pressure and for mechanical ventilation. Salbutamol may slightly reduce hospital stay. Five trials are ongoing. Given the limited and low certainty of the evidence available, we could not determine whether salbutamol was safe or effective for the treatment of transient tachypnea of the newborn.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Albuterol/uso terapêutico , Taquipneia Transitória do Recém-Nascido/tratamento farmacológico , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Humanos , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Nebulizadores e Vaporizadores , Oxigenoterapia/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
4.
Respir Care ; 66(1): 144-155, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380501

RESUMO

Children requiring a tracheostomy to maintain airway patency or to facilitate long-term mechanical ventilatory support require comprehensive care and committed, trained, direct caregivers to manage their complex needs safely. These guidelines were developed from a comprehensive review of the literature to provide guidance for the selection of the type of tracheostomy tube (cuffed vs uncuffed), use of communication devices, implementation of daily care bundles, timing of first tracheostomy change, type of humidification used (active vs passive), timing of oral feedings, care coordination, and routine cleaning. Cuffed tracheostomy tubes should only be used for positive-pressure ventilation or to prevent aspiration. Manufacturer guidelines should be followed for cuff management and tracheostomy tube hygiene. Daily care bundles, skin care, and the use of moisture-wicking materials reduce device-associated complications. Tracheostomy tubes may be safely changed at postoperative day 3, and they should be changed with some regularity (at a minimum of every 1-2 weeks) as well as on an as-needed basis, such as when an obstruction within the lumen occurs. Care coordination can reduce length of hospital and ICU stay. Published evidence is insufficient to support recommendations for a specific device to humidify the inspired gas, the use of a communication device, or timing for the initiation of feedings.


Assuntos
Respiração com Pressão Positiva , Guias de Prática Clínica como Assunto , Traqueostomia , Criança , Humanos , Ventilação com Pressão Positiva Intermitente
6.
PLoS One ; 15(12): e0243971, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332454

RESUMO

BACKGROUND: Expiratory flow-initiated pressure-controlled inverse ratio ventilation (EF-initiated PC-IRV) reduces physiological dead space. We hypothesised that EF-initiated PC-IRV would be lung protective compared with volume-controlled ventilation (VCV). METHODS: Twenty-eight men undergoing robot-assisted laparoscopic radical prostatectomy were enrolled in this randomised controlled trial. The EF-initiated PC-IRV group (n = 14) used pressure-controlled ventilation with the volume guaranteed mode. The inspiratory to expiratory (I:E) ratio was individually adjusted by observing the expiratory flow-time wave. The VCV group (n = 14) used the volume control mode with a 1:2 I:E ratio. The Mann-Whitney U test was used to compare differences in the serum cytokine levels. RESULTS: There were no significant differences in serum IL-6 between the EF-initiated PC-IRV (median 34 pg ml-1 (IQR 20.5 to 63.5)) and VCV (31 pg ml-1 (24.5 to 59)) groups (P = 0.84). The physiological dead space rate (physiological dead space/expired tidal volume) was significantly reduced in the EF-initiated PC-IRV group as compared with that in the VCV group (0.31 ± 0.06 vs 0.4 ± 0.07; P<0.001). The physiological dead space rate was negatively correlated with the forced vital capacity (% predicted) in the VCV group (r = -0.85, P<0.001), but not in the EF-initiated PC-IRV group (r = 0.15, P = 0.62). Two patients in the VCV group had permissive hypercapnia with low forced vital capacity (% predicted). CONCLUSIONS: There were no differences in the lung-protective properties between the two ventilatory strategies. However, EF-initiated PC-IRV reduced physiological dead space rate; thus, it may be useful for reducing the ventilatory volume that is necessary to maintain normocapnia in patients with low forced vital capacity (% predicted) during robot-assisted laparoscopic radical prostatectomy.


Assuntos
Expiração/fisiologia , Pulmão/fisiologia , Respiração com Pressão Positiva , Respiração Artificial/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente , Masculino , Pessoa de Meia-Idade , Troca Gasosa Pulmonar/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Adulto Jovem
7.
J Cardiothorac Surg ; 15(1): 301, 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028398

RESUMO

BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. CASE PRESENTATION: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. CONCLUSIONS: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Enfisema Mediastínico/etiologia , Pneumonia Viral/complicações , Pneumopericárdio/etiologia , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente/métodos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/terapia , Pessoa de Meia-Idade , Oxigenoterapia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumopericárdio/diagnóstico , Pneumotórax/diagnóstico , Pneumotórax/terapia , Radiografia Torácica , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios X
8.
Cochrane Database Syst Rev ; 10: CD002975, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33058139

RESUMO

BACKGROUND: The application of continuous positive airway pressure (CPAP) has been shown to have some benefits in the treatment of preterm infants with respiratory distress. CPAP has the potential to reduce lung damage, particularly if applied early before atelectasis has occurred. Early application may better conserve an infant's own surfactant stores and consequently may be more effective than later application. OBJECTIVES: • To determine if early compared with delayed initiation of CPAP results in lower mortality and reduced need for intermittent positive-pressure ventilation in preterm infants in respiratory distress ○ Subgroup analyses were planned a priori on the basis of weight (with subdivisions at 1000 grams and 1500 grams), gestation (with subdivisions at 28 and 32 weeks), and according to whether surfactant was used ▫ Sensitivity analyses based on trial quality were also planned ○ For this update, we have excluded trials using continuous negative pressure SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 6), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literatue (CINAHL), on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-RCTs. SELECTION CRITERIA: We included trials that used random or quasi-random allocation to either early or delayed CPAP for spontaneously breathing preterm infants in respiratory distress. DATA COLLECTION AND ANALYSIS: We used the standard methods of Cochrane and Cochrane Neonatal, including independent assessment of trial quality and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: We found four studies that recruited a total of 119 infants. Two were quasi-randomised, and the other two did not provide details on the method of randomisation or allocation used. None of these studies used blinding of the intervention or the outcome assessor. Evidence showed uncertainty about whether early CPAP has an effect on subsequent use of intermittent positive-pressure ventilation (IPPV) (typical risk ratio (RR) 0.77, 95% confidence interval (CI) 0.43 to 1.38; typical risk difference (RD) -0.08, 95% CI -0.23 to 0.08; I² = 0%, 4 studies, 119 infants; very low-certainty evidence) or mortality (typical RR 0.93, 95% CI 0.43 to 2.03; typical RD -0.02, 95% CI -0.15 to 0.12; I² = 33%, 4 studies, 119 infants; very low-certainty evidence). The outcome 'failed treatment' was not reported in any of these studies. There was an uncertain effect on air leak (pneumothorax) (typical RR 1.09, 95% CI 0.39 to 3.04, I² = 0%, 3 studies, 98 infants; very low-certainty evidence). No trials reported intraventricular haemorrhage or necrotising enterocolitis. No cases of retinopathy of prematurity were reported in one study (21 infants). One case of bronchopulmonary dysplasia was reported in each group in one study involving 29 infants. Long-term outcomes were not reported. AUTHORS' CONCLUSIONS: All four small trials included in this review were performed in the 1970s or the early 1980s, and we are very uncertain whether early application of CPAP confers clinical benefit in the treatment of respiratory distress, or whether it is associated with any adverse effects. Further trials should be directed towards establishing the appropriate level of CPAP and the timing and method of administration of surfactant when used along with CPAP.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Recém-Nascido Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Viés , Displasia Broncopulmonar/epidemiologia , Humanos , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/estatística & dados numéricos , Pneumotórax/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade
9.
Cochrane Database Syst Rev ; 10: CD002271, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33058208

RESUMO

BACKGROUND: Respiratory distress, particularly respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress, as well as for the prevention of apnoea, and in weaning from IPPV. Its use in the treatment of RDS might reduce the need for IPPV and its sequelae. OBJECTIVES: To determine the effect of continuous distending pressure in the form of CPAP on the need for IPPV and associated morbidity in spontaneously breathing preterm infants with respiratory distress. SEARCH METHODS: We used the standard strategy of Cochrane Neonatal to search CENTRAL (2020, Issue 6); Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions; and CINAHL on 30 June 2020. We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: All randomised or quasi-randomised trials of preterm infants with respiratory distress were eligible. Interventions were CPAP by mask, nasal prong, nasopharyngeal tube or endotracheal tube, compared with spontaneous breathing with supplemental oxygen as necessary. DATA COLLECTION AND ANALYSIS: We used standard methods of Cochrane and its Neonatal Review Group, including independent assessment of risk of bias and extraction of data by two review authors. We used the GRADE approach to assess the certainty of evidence. Subgroup analyses were planned on the basis of birth weight (greater than or less than 1000 g or 1500 g), gestational age (groups divided at about 28 weeks and 32 weeks), timing of application (early versus late in the course of respiratory distress), pressure applied (high versus low) and trial setting (tertiary compared with non-tertiary hospitals; high income compared with low income) MAIN RESULTS: We included five studies involving 322 infants; two studies used face mask CPAP, two studies used nasal CPAP and one study used endotracheal CPAP and continuing negative pressure for a small number of less ill babies. For this update, we included one new trial. CPAP was associated with lower risk of treatment failure (death or use of assisted ventilation) (typical risk ratio (RR) 0.64, 95% confidence interval (CI) 0.50 to 0.82; typical risk difference (RD) -0.19, 95% CI -0.28 to -0.09; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% CI 4 to 11; I2 = 50%; 5 studies, 322 infants; very low-certainty evidence), lower use of ventilatory assistance (typical RR 0.72, 95% CI 0.54 to 0.96; typical RD -0.13, 95% CI -0.25 to -0.02; NNTB 8, 95% CI 4 to 50; I2 = 55%; very low-certainty evidence) and lower overall mortality (typical RR 0.53, 95% CI 0.34 to 0.83; typical RD -0.11, 95% CI -0.18 to -0.04; NNTB 9, 95% CI 2 to 13; I2 = 0%; 5 studies, 322 infants; moderate-certainty evidence). CPAP was associated with increased risk of pneumothorax (typical RR 2.48, 95% CI 1.16 to 5.30; typical RD 0.09, 95% CI 0.02 to 0.16; number needed to treat for an additional harmful outcome (NNTH) 11, 95% CI 7 to 50; I2 = 0%; 4 studies, 274 infants; low-certainty evidence). There was no evidence of a difference in bronchopulmonary dysplasia, defined as oxygen dependency at 28 days (RR 1.04, 95% CI 0.35 to 3.13; I2 = 0%; 2 studies, 209 infants; very low-certainty evidence). The trials did not report use of surfactant, intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis and neurodevelopment outcomes in childhood. AUTHORS' CONCLUSIONS: In preterm infants with respiratory distress, the application of CPAP is associated with reduced respiratory failure, use of mechanical ventilation and mortality and an increased rate of pneumothorax compared to spontaneous breathing with supplemental oxygen as necessary. Three out of five of these trials were conducted in the 1970s. Therefore, the applicability of these results to current practice is unclear. Further studies in resource-poor settings should be considered and research to determine the most appropriate pressure level needs to be considered.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Recém-Nascido Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Displasia Broncopulmonar/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde , Pneumotórax/etiologia , Surfactantes Pulmonares/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Insuficiência Respiratória/prevenção & controle , Viés de Seleção , Falha de Tratamento
10.
F1000Res ; 92020.
Artigo em Inglês | MEDLINE | ID: mdl-32269759

RESUMO

Ventilation-induced lung injury results from mechanical stress and strain that occur during tidal ventilation in the susceptible lung. Classical descriptions of ventilation-induced lung injury have focused on harm from positive pressure ventilation. However, injurious forces also can be generated by patient effort and patient-ventilator interactions. While the role of global mechanics has long been recognized, regional mechanical heterogeneity within the lungs also appears to be an important factor propagating clinically significant lung injury. The resulting clinical phenotype includes worsening lung injury and a systemic inflammatory response that drives extrapulmonary organ failures. Bedside recognition of ventilation-induced lung injury requires a high degree of clinical acuity given its indistinct presentation and lack of definitive diagnostics. Yet the clinical importance of ventilation-induced lung injury is clear. Preventing such biophysical injury remains the most effective management strategy to decrease morbidity and mortality in patients with acute respiratory distress syndrome and likely benefits others at risk.


Assuntos
Lesão Pulmonar , Respiração Artificial , Humanos , Ventilação com Pressão Positiva Intermitente , Lesão Pulmonar/urina , Respiração
11.
PLoS One ; 15(3): e0229944, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32131083

RESUMO

Controlled mechanical ventilation (CMV) can cause diaphragmatic motionlessness to induce diaphragmatic dysfunction. Partial maintenance of spontaneous breathing (SB) can reduce ventilation-induced diaphragmatic dysfunction (VIDD). However, to what extent SB is maintained in CMV can attenuate or even prevent VIDD has been rarely reported. The current study aimed to investigate the relationship between SB intensity and VIDD and to identify what intensity of SB maintained in CMV can effectively avoid VIDD. Adult rats were randomly divided according to different SB intensities: SB (0% pressure controlled ventilation (PCV)), high-intensity SB (20% PCV), medium-intensity SB (40% PCV), medium-low intensity SB (60% PCV), low-intensity SB (80% PCV), and PCV (100% PCV). The animals underwent 24-h controlled mechanical ventilation (CMV). The transdiaphragmatic pressure (Pdi), the maximal Pdi (Pdi max) when phrenic nerves were stimulated, Pdi/Pdi max, and the diaphragmatic tonus under different frequencies of electric stimulations were determined. Calpain and caspase-3 were detected using ELISA and the cross-section areas (CSAs) of different types of muscle fibers were measured. The Pdi showed a significant decrease from 20% PCV and the Pdi max showed a significant decrease from 40% PCV (P<0.05). In vivo and vitro diaphragmatic tonus exhibited a significant decrease from 40% PCV and 20% PCV, respectively (P<0.05). From 20% PCV, the CSAs of types I, IIa, and IIb/x muscle fibers showed significant differences, which reached the lowest levels at 100% PCV. SB intensity is negatively associated with the development of VIDD. Maintenance of SB at an intensity of 60%-80% may effectively prevent the occurrence of VIDD.


Assuntos
Diafragma/fisiopatologia , Pulmão/fisiopatologia , Respiração Artificial/métodos , Respiração , Animais , Humanos , Ventilação com Pressão Positiva Intermitente , Fibras Musculares Esqueléticas/fisiologia , Ratos
12.
Cochrane Database Syst Rev ; 3: CD012935, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32176939

RESUMO

BACKGROUND: Diaphragm-triggered non-invasive respiratory support, commonly referred to as NIV-NAVA (non-invasive neurally adjusted ventilatory assist), uses the electrical activity of the crural diaphragm to trigger the start and end of a breath. It provides variable inspiratory pressure that is proportional to an infant's changing inspiratory effort. NIV-NAVA has the potential to provide effective, non-invasive, synchronised, multilevel support and may reduce the need for invasive ventilation; however, its effects on short- and long-term outcomes, especially in the preterm infant, are unclear. OBJECTIVES: To assess the effectiveness and safety of diaphragm-triggered non-invasive respiratory support in preterm infants (< 37 weeks' gestation) when compared to other non-invasive modes of respiratory support (nasal intermittent positive pressure ventilation (NIPPV); nasal continuous positive airway pressure (nCPAP); high-flow nasal cannulae (HFNC)), and to assess preterm infants with birth weight less than 1000 grams or less than 28 weeks' corrected gestation at the time of intervention as a sub-group. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 5), MEDLINE via PubMed (1946 to 10 May 2019), Embase (1947 to 10 May 2019), and CINAHL (1982 to 10 May 2019). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials that compared diaphragm-triggered non-invasive versus other non-invasive respiratory support in preterm infants. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, assessed trial quality and extracted data from included studies. We performed fixed-effect analyses and expressed treatment effects as mean difference (MD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs). We used the generic inverse variance method to analyse specific outcomes for cross-over trials. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS: There were two small randomised controlled trials including a total of 23 infants eligible for inclusion in the review. Only one trial involving 16 infants included in the analysis reported on either of the primary outcomes of the review. This found no difference in failure of modality between NIV-NAVA and NIPPV (RR 0.33, 95% CI 0.02 to 7.14; RD -0.13, 95% CI -0.41 to 0.16; 1 study, 16 infants; heterogeneity not applicable). Both trials reported on secondary outcomes of the review, specific for cross-over trials (total 22 infants; 1 excluded due to failure of initial modality). One study involving seven infants reported a significant reduction in maximum FiO2 with NIV-NAVA compared to NIPPV (MD -4.29, 95% CI -5.47 to -3.11; heterogeneity not applicable). There was no difference in maximum electric activity of the diaphragm (Edi) signal between modalities (MD -1.75, 95% CI -3.75 to 0.26; I² = 0%) and a significant increase in respiratory rate with NIV-NAVA compared to NIPPV (MD 7.22, 95% CI 0.21 to 14.22; I² = 72%) on a meta-analysis of two studies involving a total of 22 infants. The included studies did not report on other outcomes of interest. AUTHORS' CONCLUSIONS: Due to limited data and very low certainty evidence, we were unable to determine if diaphragm-triggered non-invasive respiratory support is effective or safe in preventing respiratory failure in preterm infants. Large, adequately powered randomised controlled trials are needed to determine if diaphragm-triggered non-invasive respiratory support in preterm infants is effective or safe.


Assuntos
Diafragma/fisiologia , Recém-Nascido Prematuro , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Recém-Nascido , Suporte Ventilatório Interativo , Ventilação com Pressão Positiva Intermitente , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(2): 249-260, 2020 Feb 10.
Artigo em Chinês | MEDLINE | ID: mdl-32164138

RESUMO

Objective: To evaluate the relative safety of different ventilation methods regarding mortality and rates of complication, on neonatal respiratory distress syndrome (NRDS). Methods: Network Meta-analysis was used to collect data on randomized controlled trials of pulmonary ventilation strategies in preterm infants with a mean gestational age of less than 32 weeks. Diagnostic criteria on NRDS were published in the PubMed, Cochrane, Web of Science, EBSCO, and Springer Link databases from January 1986 to June 2018. Revman 5.3 software was used to evaluate the quality of studies, based on the Cochrane quality assessment tool. Data were analyzed by Bayesian and frequency methods, using both Win BUGS 1.4.3 and STATA 13.0 software. Safety of different ventilation strategies for NRDS mortality and complications would include intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA) and retinopathy of prematurity (ROP) and were evaluated. Counted data was displayed by OR and 95%CI. Results: A total of 31 RCTs were included in this paper, including 5 827 preterm infants and 11 ventilation strategies. There were no statistically significant differences appearing in 11 ventilation strategies on mortality, PDA or ROP. IVH results were reported in 28 studies. Compared with nasal intermittent positive pressure ventilation (NIPPV), both high- frequency oscillation ventilation (HFOV) (OR=3.33, 95%CI: 1.08-16.67, P<0.05) and synchronized intermittent mechanical ventilation (SIMV) (OR=8.22, 95%CI: 1.25-29.44, P<0.05) schemes seemed to have increased the risk of IVH in preterm infants with NRDS. NIPPV appeared the optimal ventilation strategy in the rankings of cumulative probability. Results on clustering showed that NIPPV was probably the best ventilation strategy for children with NRDS after considering the orders of IVH, PDA and ROP on mortality, respectively. However, HFOV, IMV, and SIMV did not seem to be the ideal ventilated strategies. Conclusions: Most of the clinical decision makers might prefer using NIPPV in the treatment of children with NRDS through mechanical ventilation systems to reduce both the incidence and death caused by IVH, PDA and ROP. It was not recommended to use HFOV, SIMV and IMV in treating NRDS with gestational less than 32 weeks. We suggested that larger numbers of multi-center RCTs ba carried out to make the above conclusions more convincing.


Assuntos
Respiração Artificial/efeitos adversos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Teorema de Bayes , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Ventilação com Pressão Positiva Intermitente/métodos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
16.
Pediatr Pulmonol ; 55(5): 1131-1138, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32150670

RESUMO

BACKGROUND: Pressure rise time (PRT), also known as slope time to the peak inflating pressure can be set on some modern neonatal ventilators. On other ventilators, PRT is determined by the set circuit flow. Changing slope time can affect mean airway pressure (MAP), oxygenation, and carbon dioxide elimination. Our aim was to investigate the effect of PRT on ventilator parameters and gas exchange during volume-guaranteed ventilation. METHODS: In a crossover study, 12 infants weighing greater than 2 kg were ventilated using a Dräger Babylog VN500 ventilator with synchronized intermittent positive pressure ventilation with volume guarantee (SIPPV-VG) and pressure support ventilation with volume guarantee (PSV-VG). During both modes PRTs between 0.08 and 0.40 seconds were used in 15-minute epochs. Data from the ventilator and patient monitors were downloaded with 1- and 100-Hz sampling rate and analyzed using the Python computer language. RESULTS: During PSV-VG, longer PRTs were associated with longer inspiratory time (P < .0001) and with lower peak inflating pressure (PIP; P = .003), but the MAP was similar. During SIPPV-VG the PIP was not significantly different; however, MAP was lower with longer PRT (P = .001). With a short PRT (0.08 seconds), the PIP was higher during PSV-VG than during SIPPV-VG (19.8 vs 16.5 mbar; P = .042). There were no significant differences in tidal volume delivery, respiratory rate, minute volume, oxygen saturations, or end-tidal CO2 with different PRTs in either mode. CONCLUSIONS: During SIPPV-VG or PSV-VG, using short or long PRTs affects some ventilation parameters but does not significantly change oxygenation or carbon dioxide elimination.


Assuntos
Ventilação com Pressão Positiva Intermitente/métodos , Dióxido de Carbono/fisiologia , Estudos Cross-Over , Humanos , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/instrumentação , Oxigênio/fisiologia , Pressão , Respiração , Testes de Função Respiratória , Ventiladores Mecânicos
17.
Medicine (Baltimore) ; 99(8): e19084, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080082

RESUMO

BACKGROUND: Sustained Inflations (SI) and Intermittent Positive Pressure Ventilation (IPPV) are two interventions to prevent Bronchopulmonary dysplasia (BPD). The aim of this study is to assess the effect of these two interventions. METHODS: The databases of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) will be comprehensively searched from inception to September 2019. All RCTs and quasi-RCTs which compare the efficacy of SI vs IPPV among preterm infants are eligible. We will assess the methodological quality using the Cochrane Handbook version 5.1.0. A meta-analysis will be performed using RevMan 5.3 software and the results will be presented using risk ratios (RRs) and 95% confidence intervals (CIs). CONCLUSIONS: This study will provide strong evidence for assessing the effect of SI and IPPV on BPD or death among preterm infants. PROSPERO REGISTRATION NUMBER: CRD42019135816.


Assuntos
Displasia Broncopulmonar/prevenção & controle , Insuflação/efeitos adversos , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Peso ao Nascer , Displasia Broncopulmonar/mortalidade , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Insuflação/instrumentação , Ventilação com Pressão Positiva Intermitente/instrumentação , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Lesão Pulmonar Induzida por Ventilação Mecânica/mortalidade
20.
Arch. bronconeumol. (Ed. impr.) ; 56(1): 35-41, ene. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-186464

RESUMO

Sleep is considered an essential part of life and plays a vital role in good health and well-being. Equally important as a balanced diet and adequate exercise, quality and quantity of sleep are essential for maintaining good health and quality of life. Sleep-disordered breathing is one of the most prevalent conditions that compromises the quality and duration of sleep, with obstructive sleep apnea (OSA) being the most prevalent disorder among these conditions. OSA is a chronic and highly prevalent disease that is considered to be a true public health problem. OSA has been associated with increased cardiovascular, neurocognitive, metabolic and overall mortality risks, and its management is a challenge facing the health care system. To establish the main future lines of research in sleep respiratory medicine, the Spanish Sleep Network (SSN) promoted the 1st World Café experts' meeting. The overall vision was established by consensus as "Sleep as promoter of health and the social impact of sleep disturbances". Under this leitmotiv and given that OSA is the most prevalent sleep disorder, five research lines were established to develop a new comprehensive approach for OSA management: (1) an integrated network for the comprehensive management of OSA; (2) the biological impact of OSA on comorbidities with high mortality, namely, cardiovascular and metabolic diseases, neurocognitive diseases and cancer; (3) Big Data Analysis for the identification of OSA phenotypes; (4) personalized medicine in OSA; and (5) OSA in children: current needs and future perspectives


El sueño se considera una parte esencial de la vida y es vital para una buena salud y para el bienestar. De igual importancia que una dieta equilibrada y una adecuada actividad física, la calidad y la cantidad del sueño son esenciales para mantener una buena salud y calidad de vida. Las alteraciones respiratorias del sueño son los trastornos más prevalentes que comprometen la calidad y duración del sueño, siendo el síndrome de la apnea obstructiva del sueño (SAHS) el más frecuente. El SAHS es una enfermedad de elevada prevalencia que se considera un problema de salud pública. Se ha asociado con aumento del riesgo cardiovascular, neurocognitivo, metabólico y especialmente de mortalidad, y su manejo representa un reto para el sistema de salud. Para establecer las principales líneas futuras de investigación en medicina respiratoria del sueño, el Spanish Sleep Network promovió la primera edición del World Cafe experts' meeting. El mensaje principal «El sueño como promotor de la salud y el impacto social de los trastornos del sueño» se estableció por consenso. Bajo este lema y dado que el SAHS es el trastorno del sueño más prevalente, se establecieron cinco líneas de investigación para desarrollar una aproximación completa para el manejo de este síndrome: 1) Una red integrada para el manejo del SAHS; 2) El impacto biológico del SAHS en las comorbilidades con elevada mortalidad como la enfermedad cardiovascular, las enfermedades metabólicas y neurocognitivas y el cáncer; 3) El análisis de grandes bases de datos para la identificación de fenotipos del SAHS; 4) Medicina personalizada en el SAHS, y 5) El SAHS en niños: necesidades actuales y perspectivas futuras


Assuntos
Humanos , Assistência Integral à Saúde/tendências , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Ventilação com Pressão Positiva Intermitente/métodos , Apneia Obstrutiva do Sono/complicações , Respiração com Pressão Positiva/métodos , Big Data , Fenótipo
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