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1.
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
2.
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
7.
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
8.
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
9.
Zhongguo Dang Dai Er Ke Za Zhi ; 21(12): 1234-1238, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31874666

RESUMO

Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.


Assuntos
Ventilação de Alta Frequência , Doenças do Prematuro , Síndrome do Desconforto Respiratório do Recém-Nascido , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente
11.
Pediatr Pulmonol ; 54(11): 1742-1746, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31373180

RESUMO

Neurally adjusted ventilatory assistance (NAVA) can overcome technical difficulties with synchronizing noninvasive ventilation breaths with the patient, a modality often used in very low birthweight infants (VLBW) with apnea of prematurity (AOP). This study is a retrospective single-center investigation into whether NAVA-synchronized noninvasive (niNAVA) ventilation is better than nonsynchronized (nasal intermittent positive pressure ventilation [nIPPV]) for symptomatic apnea in VLBW infants. Nursing records of apnea, bradycardia, and/or desaturations were abstracted from the electronic medical records of 108 VLBW infants admitted to the neonatal intensive care unit (NICU) from 2015 to 2017 who received either of the two modalities, 61 epochs of niNAVA totaling 488 days and 103 epochs of nIPPV totaling 886.5 days. niNAVA was associated with a significant reduction in the number of isolated bradycardic events/day (0.48 ± 0.14 vs 1.35 ± 0.27; P = .019) and overall bradycardias/day (2.42 ± 0.47 vs 4.02 ± 0.53; P = .042) and there were more epochs with no events with niNAVA compared with nIPPV (23.0% vs 6.8%; P = .004). These results justify a prospective trial of NAVA-synchronized noninvasive ventilation for VLBW infants with caffeine-resistant AOP.


Assuntos
Apneia/terapia , Bradicardia/terapia , Suporte Ventilatório Interativo , Ventilação com Pressão Positiva Intermitente , Ventilação não Invasiva , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Masculino , Estudos Retrospectivos
12.
Clin Perinatol ; 46(3): 517-536, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31345544

RESUMO

Continuous positive airway pressure (CPAP), noninvasive intermittent positive pressure ventilation (NIPPV), and heated humidified high-flow nasal cannula (HHFNC) are modes of noninvasive respiratory support used in neonatal practice. These modes of noninvasive respiratory support may obviate mechanical ventilation, prevent extubation failure, and reduce the risk of developing bronchopulmonary dysplasia. Although the physiologic bases of CPAP and HHFNC are well delineated, and their modes and practical application consistent, those of NIPPV are unproven and varied. Available evidence suggests that NIPPV is superior to CPAP as a primary and postextubation respiratory support in preterm infants.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Doenças do Prematuro/terapia , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/métodos , Idade Gestacional , Humanos , Recém-Nascido , Nariz , Respiração Artificial
13.
Saudi Med J ; 40(7): 687-693, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287129

RESUMO

OBJECTIVES: To assess the insertion and ventilation of the laryngeal mask airway (LMA) classic while using different head positions with or without muscle relaxant. METHODS: This is a double-blind randomized clinical trial. Patients scheduled for ureteral calculus surgery at Shanghai General Hospital, Shanghai, China were recruited between November 2017 and November 2018. A total of 132 adults were consecutively selected. Patients were randomly divided into 4 groups according to head positioning and muscle relaxant use. An 8-cm-high pillow was used to achieve the sniffing position. The insertion time, initial peak pressure (Ppeak), mean pressure (Pmean) of the airway during intermittent positive pressure ventilation (primary endpoint) and fiberoptic score of the LMA position (secondary endpoint) were evaluated via electronic bronchoscopy through the mask bar. All adverse events were recorded. Results: Data were analyzed by ANOVA, 2-way ANOVA, Chi-squared, Cochran-Mantel-Haenszel, and Kruskal-Wallis tests. The insertion time required for the first attempt, fiberoptic score, Ppeak and Pmean did not differ among the groups. However, the incidence of adverse events in groups not using muscle relaxant was higher than in those using muscle relaxant. Conclusion: Use of a sniffing position and muscle relaxant slightly eased the insertion of the LMA but did not affect the fiberoptic score or ventilation parameters. Using a muscle relaxant, but not the sniffing position, reduced the incidence of adverse effects.


Assuntos
Anestesia Geral/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Máscaras Laríngeas , Fármacos Neuromusculares Despolarizantes/uso terapêutico , Posicionamento do Paciente/métodos , Succinilcolina/uso terapêutico , Adulto , Idoso , Anestésicos Intravenosos/uso terapêutico , Broncoscopia , China , Método Duplo-Cego , Feminino , Fentanila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/uso terapêutico , Cálculos Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos , Adulto Jovem
14.
Ann Ital Chir ; 90: 392-397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31308266

RESUMO

AIM: It is necessary for an effective NIV application to provide proper modality selection, sufficient minute ventilation (MV), also the amount of leakage on the circuit must be minimized and patient-ventilator adaptation must be achieved. METHODS: 30 patients with acute respiratory failure as a result of either internal or postoperative reasons were included in the study. Patient comfort was analyzed with a scale ranging from 0 to 2. Firstly the patient was used for two hours in BIPAP modality, after then the AVAPS modality (Period Av) was applied by setting the required rates the same mask. During BIPAP and AVAPS, arterial blood gases analysis, comfort scale and hemodynamic parameters were recorded in the 30th minute, 1st hour and 2nd hour. RESULTS: According to the assessment of arterial blood gases, the pH changes of both periods were statistically significant compared to their baseline values (p=0.001). Treatment compliance of the patients was significantly better at AVAPS modality at all times (p = 0.015, p = 0.008, p = 0.008, respectively). CONCLUSIONS: According to the results obtained from this study, the AVAPS modality has positive effects on pH and gas variation and patient comfort; therefore, it can be confidently used in clinical practice. KEY WORDS: Average Volume Assured Pressure Support, Bilevel Continuous Positive Airway Pressure, Intensive Care Units, Noninvasive Ventilation, Patients Compliance.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Hipercapnia/terapia , Ventilação com Pressão Positiva Intermitente/métodos , Cooperação do Paciente , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono/sangue , Comorbidade , Estudos Transversais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipercapnia/sangue , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Resultado do Tratamento
15.
PLoS One ; 14(6): e0217768, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31181092

RESUMO

BACKGROUND: To achieve gas exchange goals and mitigate lung injury, infants who fail with conventional ventilation (CV) are generally switched to high-frequency oscillatory ventilation (HFOV). Although preferred in many neonatal intensive care units (NICUs), research on this type of rescue HFOV has not been reported recently. METHODS: An online registry database for a multicenter, prospective study was set to evaluate factors affecting the response of newborn infants to rescue HFOV treatment. The study population consisted of 372 infants with CV failure after at least 4 hours of treatment in 23 participating NICUs. Patients were grouped according to their final outcome as survived (Group S) or as died or received extracorporeal membrane oxygenation (ECMO) (Group D/E). Patients' demographic characteristics and underlying diseases in addition to their ventilator settings, arterial blood gas (ABG) analysis results at 0, 1, 4, and 24 hours, type of device, ventilation duration, and complications were compared between groups. RESULTS: HFOV as rescue treatment was successful in 58.1% of patients. Demographic and treatment parameters were not different between groups, except that infants in Group D/E had lower birthweight (BW) (1655 ± 1091 vs. 1858 ± 1027 g, p = 0.006), a higher initial FiO2 setting (83% vs. 72%, p < 0.001), and a higher rate of nitric oxide exposure (21.8% vs. 11.1%, p = 0.004) in comparison to infants who survived (Group S). The initial cut-offs for a successful response on ABG were defined as pH >7.065 (OR: 19.74, 95% CI 4.83-80.6, p < 0.001), HCO3 >16.35 mmol/L (OR: 1.06, 95% CI 1.01-1.1, p = 0.006), and lactate level <3.75 mmol/L (OR: 1.09%95 CI 1.01-1.16, p = 0.006). Rescue HFOV duration was associated with retinopathy of prematurity (p = 0.005) and moderate or severe chronic lung disease (p < 0.001), but not with patent ductus arteriosus or intraventricular hemorrhage, in survivors (p > 0.05). CONCLUSION: Rescue HFOV as defined for this population was successful in more than half of the patients with CV failure. Although the response was not associated with gestational age, underlying disease, device used, or initial MV settings, it seemed to be more effective in patients with higher BW and those not requiring nitric oxide. Initial pH, HCO3, and lactate levels on ABG may be used as predictors of a response to rescue HFOV.


Assuntos
Ventilação de Alta Frequência/mortalidade , Ventilação de Alta Frequência/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Peso ao Nascer , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Ventilação com Pressão Positiva Intermitente/métodos , Ventilação com Pressão Positiva Intermitente/mortalidade , Lesão Pulmonar/prevenção & controle , Masculino , Estudos Prospectivos , Respiração , Respiração Artificial/métodos , Insuficiência Respiratória , Turquia , Ventilação/métodos
16.
J Neonatal Perinatal Med ; 12(3): 249-253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30932902

RESUMO

AIM: To evaluate the association between the use of nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV) with the development of bronchopulmonary dysplasia (BPD). METHODS: This is a single center retrospective cohort analysis of infants born at ≤1000 grams and ≤28 weeks gestation with respiratory distress treated with nCPAP or NIPPV. Groups were compared using Student's t test or chi-square, and associations estimated by logistic regression. RESULTS: Compared to nCPAP, infants who received NIPPV had a higher incidence of moderate to severe (M-S) BPD (84.2 vs 65.5%, p = 0.044) and death or severe BPD (75.0 vs 47.6%, p = 0.003). Each day on NIPPV was associated with an increased risk of M-S BPD (OR 1.08, p < 0.001) and an increased risk of death or severe BPD (OR 1.03, p = 0.006). After adjusting for days on oxygen, ventilator days, and days on all respiratory support, the odds of developing M-S BPD increased by 4.9% for each additional week on NIPPV (CI 2.1-7.7%, p = .0001). CONCLUSION: In this cohort, use of NIPPV was associated with an increased risk for developing BPD when compared to infants receiving nCPAP, and each additional day on NIPPV carried significant increased risk for developing BPD.


Assuntos
Displasia Broncopulmonar/etiologia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Feminino , Humanos , Recém-Nascido , Terapia Intensiva Neonatal , Masculino , Ventilação não Invasiva/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Chest ; 155(4): 740-748, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30955572

RESUMO

BACKGROUND: Nasal high-frequency oscillatory ventilation (NHFOV) has been described as supplying the combined advantages of nasal CPAP (NCPAP) and HFOV. However, its effect on preterm infants needs to be further elucidated. Our objective was to assess whether NHFOV could reduce intubation and Pco2 levels as compared with NCPAP during the postextubation phase in preterm infants. METHODS: This was a single-center, randomized, controlled trial, and it was registered at clinicaltrials.gov (NCT03140891) and conducted between May 2017 and May 2018. Ventilated infants born at less than 37 weeks' gestational age and ready to be extubated were included and randomized to either the NHFOV or NCPAP group. Primary outcomes were the incidence of reintubation within 1 week and the Pco2 level within 6 h. RESULTS: A total of 206 preterm infants were included. Of them, 127 (61.7%) were diagnosed with respiratory distress syndrome, 53 (25.7%) with ARDS, and 26 (12.6%) with both respiratory distress syndrome and ARDS. Comparing with NCPAP, NHFOV significantly reduced the reintubation rate (16:87 vs 35:68; 95% CI, 0.18-0.70; P = .002), especially in the subgroup with a gestational age of ≤ 32 weeks (12:34 vs 25:20; 95% CI, 0.12-0.68; P = .004). The Pco2 level was also significant lower in the NHFOV group (49.6 ± 8.7 vs 56.9 ± 9.9; 95% CI, -9.95 to -4.80; P = < .001). Moreover, NHFOV significantly reduced the reintubation rate in preterm infants with ARDS (10:33 vs 21:15; 95% CI, 0.08-0.57; P = .002). CONCLUSIONS: NHFOV was shown to be superior to NCPAP in avoiding reintubation, especially in very preterm infants and those infants diagnosed with ARDS. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03140891; URL: www.clinicaltrials.gov.


Assuntos
Extubação/efeitos adversos , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Insuficiência Respiratória/etiologia , Feminino , Seguimentos , Idade Gestacional , Humanos , Recém-Nascido , Intubação Intratraqueal , Masculino , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
19.
Dtsch Arztebl Int ; 116(11): 177-183, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-31014448

RESUMO

BACKGROUND: Invasive mechanical ventilation (IMV) has been replaced by early continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS) in preterm infants aiming to reduce the rate of bronchopulmonary dysplasia (BPD). Subsequently, modern non-invasive ventilation strategies (NIV) were introduced into clinical practice with limited evidence of effects on pulmonary and neurodevelopmental outcomes. METHODS: We performed a selective literature search in PubMed including randomized controlled trials (RCT) (n ≥ 200) and meta-analyses published in the field of NIV in neonatology and follow-up studies focusing on long term pulmonary and neurodevelopmental outcomes. RESULTS: Individual studies do not show a significant risk reduction for the combined endpoint death or BPD in preterm infants caused by early CPAP in RDS when compared to primary intubation. One meta-analysis comparing four studies found CPAP significantly reduces the risk of BPD or death (relative risk: 0.91; 95% confidence interval [0.84;0.99]). Nasal intermittent positive pressure ventilation (NIPPV) as a primary ventilation strategy reduces the rate of intubations in infants with RDS (RR: 0.78 [0.64;0.94]) when compared to CPAP but does not affect the rate of BPD (RR: 0.78 [0.58;1.06]). CONCLUSION: Early CPAP reduces the need for IMV and the risk of BPD or death in preterm infants with RDS. NIPPV may offer advantages over CPAP regarding intubation rates. Networking-based follow-up programs are required to assess the effect of NIV on long term pulmonary and neurodevelopmental outcomes.


Assuntos
Neonatologia , Ventilação não Invasiva/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/métodos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
20.
Am J Phys Med Rehabil ; 98(9): 789-793, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30969177

RESUMO

OBJECTIVE: The aim of the study was to evaluate the efficacy of noninvasive ventilatory assistance/support via mouthpiece to improve performance in 6-min walk tests for individuals with severe restrictive ventilatory disorders. DESIGN: Each subject performed the 6-min walk test breathing spontaneously and again while using mouthpiece noninvasive ventilatory assistance/support at full ventilatory support. Oxyhemoglobin saturation (O2 sat), heart rate, Borg scale, distance walked, and ambulation duration were recorded. RESULTS: Eighteen patients using nocturnal nasal noninvasive ventilatory assistance/support, median (interquartile range) age of 58.5 (20) yrs, were studied. Their median baseline forced vital capacity and PaCO2 were 940 (385) ml and 54.1 (6) mm Hg, respectively. All used noninvasive ventilatory assistance/support for at least overnight hours for 36 (111) mos. Because of the progression of ventilatory impairment and hypercapnia, daytime mouthpiece noninvasive ventilatory assistance/support was initiated. All the 6-min walk test parameters improved significantly by using noninvasive ventilatory assistance/support. Both initial and final values of O2 saturation significantly increased (92% [6] vs 96% [2], P < 0.001) and (80% [19] vs 85.50% [13], P = 0.001), respectively. The median distance walked increased by 43% with noninvasive ventilatory assistance/support (175 [218] m vs 250 [113] m, P = 0.017), and the total ambulation time also increased with noninvasive ventilatory assistance/support (5.45 [3] mins vs. 6 [0] mins, P = 0.008). CONCLUSIONS: The exercise tolerance of patients with severe ventilatory impairment can improve by using noninvasive ventilatory support.


Assuntos
Tolerância ao Exercício/fisiologia , Ventilação com Pressão Positiva Intermitente/métodos , Insuficiência Respiratória/terapia , Caminhada/fisiologia , Idoso , Feminino , Humanos , Masculino , Ventilação Voluntária Máxima/fisiologia , Pessoa de Meia-Idade , Oxigênio/sangue , Insuficiência Respiratória/sangue
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