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1.
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
2.
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
3.
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
4.
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
5.
Eur J Pediatr ; 178(1): 105-110, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30374754

RESUMO

Our aim was to compare the work of breathing (WOB) during synchronised nasal intermittent positive pressure ventilation (SNIPPV) and heated humidified high flow nasal cannula (HHHFNC) when used as post-extubation support in preterm infants. A randomised crossover study was undertaken of nine infants with a median gestational age of 27 (range 24-31) weeks and post-natal age of 7 (range 2-50) days. Infants were randomised to either SNIPPV or HHHFNC immediately following extubation. They were studied for 2 h on one mode and then switched to the other modality and studied for a further 2-h period. The work of breathing, assessed by measuring the pressure time product of the diaphragm (PTPdi), and thoracoabdominal asynchrony (TAA) were determined at the end of each 2-h period. The infants' inspired oxygen requirement, oxygen saturation, heart rate and respiratory rate were also recorded. The median PTPdi was lower on SNIPPV than on HHHFNC (232 (range 130-352) versus 365 (range 136-449) cmH2O s/min, p = 0.0077), and there was less thoracoabdominal asynchrony (13.4 (range 8.5-41.6) versus 36.1 (range 4.3-50.4) degrees, p = 0.038).Conclusion: In prematurely born infants, SNIPPV compared to HHHFNC post-extubation reduced the work of breathing and thoracoabdominal asynchrony. What is Known: • The work of breathing and extubation failure are not significantly different in prematurely-born infants supported by HHHFNC or nCPAP. • SNIPPV reduces inspiratory effort and increases tidal volume and carbon dioxide exchange compared to nCPAP in prematurely born infants. What is New: • SNIPPV, as compared to HHHFNC, reduced the work of breathing in prematurely-born infants studied post-extubation. • SNIPPV, as compared to HHHFNC, reduced thoracoabdominal asynchrony in prematurely born infants studied post-extubation.


Assuntos
Extubação/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Ventilação não Invasiva/métodos , Trabalho Respiratório/fisiologia , Gasometria , Cânula , Estudos Cross-Over , Feminino , Frequência Cardíaca/fisiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Taxa Respiratória/fisiologia
6.
Arch Dis Child Fetal Neonatal Ed ; 104(4): F384-F389, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30217870

RESUMO

OBJECTIVE: High-frequency oscillatory ventilation (HFOV) is widely used in neonatology. The Dräger Babylog VN500 ventilator offers volume-guaranteed HFOV (HFOV-VG) mode when the high-frequency tidal volume (VThf) to be delivered can be set. We investigated how HFOV-VG maintains VThf in the short and longer term and how it affects other ventilator parameters and blood gases. METHODS: We downloaded ~3.2 million seconds (36.7 days) of ventilator data from 17 infants ventilated using HFOV-VG during clinical care with 1 Hz sampling rate. To process and analyse the data, we used the Python computer language. RESULTS: Overall, the median VThf was 1.93 mL/kg (IQR 1.64-2.45 mL/kg). The difference between set and delivered tidal volume was <0.2 mL/kg for 83% of time. In the individual recordings, the median VThf ranged between 1.44 and 3.31 mL/kg. During HFOV-VG, the VThf varied from 1 second to another, but it was very close to the target value when averaged over 5 min periods. After weight correction, the VThf or the diffusion coefficient of carbon dioxide (DCO2) showed weak inverse correlation with partial pressure of CO2(pCO2) (for VThf, r=-0.162, 95% CI -0.282 to -0.037, p=0.01). Uncorrected values showed no correlation. Of the 53 blood gas measurements taken when VThf was >2.5 mL/kg, there were only six (11%) with a pCO2 >8 kPa. CONCLUSIONS: During HFOV-VG, the tidal volume of oscillations varies in the short term but is maintained very close to the target over the longer term. VThf or DCO2 have poor correlation with CO2 levels but a volume of >2.5 mL/kg VThf is rarely needed.


Assuntos
Ventilação de Alta Frequência/métodos , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Humanos , Lactente , Recém-Nascido , Volume de Ventilação Pulmonar
7.
Arch Dis Child Fetal Neonatal Ed ; 104(1): F57-F62, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29353261

RESUMO

BACKGROUND AND OBJECTIVES: Delivery of inadvertent high tidal volume (VT) during positive pressure ventilation (PPV) in the delivery room is common. High VT delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if VT delivery during PPV at birth is associated with brain injury in preterm infants <29 weeks' gestation. METHODS: A flow-sensor was placed between the mask and the ventilation device. VT values were compared with recently described reference ranges for VT in spontaneously breathing preterm infants at birth. Infants were divided into two groups: VT<6 mL/kg or VT>6 mL/kg (normal and high VT, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth. RESULTS: A total of 165 preterm infants were included, 124 (75%) had high VT and 41 (25%) normal VT. The mean (SD) gestational age and birth weight in high and normal VT group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high VT group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal VT group (P=0.008).Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high VT group and 2/41 (6%) in the normal VT group (P=0.01). CONCLUSIONS: High VT delivery during mask PPV at birth was associated with brain injury. Strategies to limit VT delivery during mask PPV should be used to prevent high VT delivery.


Assuntos
Hemorragia Cerebral/etiologia , Salas de Parto/organização & administração , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Ventilação com Pressão Positiva Intermitente/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Volume de Ventilação Pulmonar
8.
Heart Lung ; 48(1): 39-45, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30336946

RESUMO

BACKGROUND: Ventilator hyperinflation (VHI) is effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated subjects; however, there are no recommendations for the best ventilator settings to perform the technique. OBJECTIVE: To compare six modes of VHI, concerning physiological markers of efficacy and safety criteria to support the selection of optimal settings. METHODS: Thirty mechanically ventilated patients underwent six modes of VHI in a randomized order. The delivered volume, expiratory flow bias criteria, overdistension, patient-ventilator asynchronies and hemodynamic variables were assessed during the interventions. RESULTS: Volume-controlled ventilation with inspiratory flow of 20 lpm (VC-CMV20) and pressure support ventilation (PSV) achieved the best effectiveness scores (P < 0.05). The target peak pressure of 40 cmH2O was associated with a high incidence of overdistension. PSV showed a lower incidence of patient-ventilator asynchronies. CONCLUSIONS: The modes VC-CMV20 and PSV are the most effective for VHI. Alveolar overdistension and patient-ventilator asynchronies must be considered when applying VHI.


Assuntos
Ventilação com Pressão Positiva Intermitente/métodos , Modalidades de Fisioterapia , Insuficiência Respiratória/terapia , Mecânica Respiratória/fisiologia , Estudos Cross-Over , Feminino , Serviços de Assistência Domiciliar , Humanos , Pessoa de Meia-Idade , Insuficiência Respiratória/fisiopatologia , Resultado do Tratamento
9.
Arch Dis Child Fetal Neonatal Ed ; 104(3): F280-F284, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30032105

RESUMO

OBJECTIVE: To describe the incidence of patient-ventilator asynchrony and different types of asynchrony in preterm infants treated with non-synchronised nasal intermittent positive pressure ventilation (nIPPV). DESIGN: An observational study was conducted including preterm infants born with a gestational age (GA) less than 32 weeks treated with non-synchronised nIPPV. During 1 hour, spontaneous breathing was measured with transcutaneous electromyography of the diaphragm simultaneous with ventilator inflations. An asynchrony index (AI), a percentage of asynchronous breaths, was calculated and the incidence of different types of inspiratory and expiratory asynchrony were reported. RESULTS: Twenty-one preterm infants with a mean GA of 26.0±1.2 weeks were included in the study. The mean inspiratory AI was 68.3%±4.7% and the mean expiratory AI was 67.1%±7.3%. Out of 5044 comparisons of spontaneous inspirations and mechanical inflations, 45.3% of the mechanical inflations occurred late, 23.3% of the mechanical inflations were early and 31.4% of the mechanical inflation were synchronous. 40.3% of 5127 expiratory comparisons showed an early termination of ventilator inflations, 26.7% of the mechanical inflations terminated late and 33.0% mechanical inflations terminated in synchrony with a spontaneous expiration. In addition, 1380 spontaneous breaths were unsupported and 611 extra mechanical inflations were delivered. CONCLUSION: Non-synchronised nIPPV results in high patient-ventilator asynchrony in preterm infants during both the inspiratory and expiratory phase of the breathing cycle. New synchronisation techniques are urgently needed and should address both inspiratory and expiratory asynchrony.


Assuntos
Recém-Nascido Prematuro/fisiologia , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Mecânica Respiratória/fisiologia , Ventiladores Mecânicos/efeitos adversos , Eletromiografia , Expiração/fisiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Inalação/fisiologia , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Masculino
10.
J Perinatol ; 38(12): 1631-1635, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30291321

RESUMO

OBJECTIVE: The study aim was to identify the frequency with which tidal volumes were achieved in a target range in infants requiring positive pressure ventilation on emergency transport. STUDY DESIGN: We performed a prospective observational study of infants requiring continued positive pressure ventilation during emergency transport after resuscitation and stabilization. Blindly recorded data were analyzed for percentage of breaths that were below range, in range, and above desired range of 4-6 mL/kg. RESULT: Fourteen patients were monitored during transport from the delivery room to the neonatal intensive care unit, and 15 patients were monitored during inter-facility transport. During delivery room transport, 21 and 7% of patients were in target range greater than 50 and 90% of the time, respectively. During inter-hospital transport, 60 and 7% of patients were in target range greater than 50 and 90% of the time, respectively. CONCLUSION: Clinical assessment of appropriate ventilation is difficult and often inaccurate during emergency neonatal transport. Improved monitoring of respiratory function to guide clinical status during transport is necessary. More investigation and implementation are urgently needed.


Assuntos
Serviços Médicos de Emergência/normas , Ventilação com Pressão Positiva Intermitente/métodos , Monitorização Fisiológica/métodos , Volume de Ventilação Pulmonar , Transporte de Pacientes , Salas de Parto/organização & administração , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/organização & administração , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Masculino , Estudos Prospectivos , Ressuscitação/métodos
11.
Resuscitation ; 132: 56-62, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30176273

RESUMO

BACKGROUND: The effects of different ventilation strategies during CPR on patient outcomes and lung physiology are still poorly understood. This study compares positive pressure ventilation (IPPV) to passive oxygenation (CPAP) and a novel ultra-low tidal volume ventilation (ULTVV) regimen in an experimental ventricular fibrillation animal model. STUDY DESIGN: Prospective randomized controlled trial. ANIMALS: 30 male German landrace pigs (16-20 weeks). METHODS: Ventricular fibrillation was induced in anesthetized and instrumented pigs and the animals were randomized into three groups. Mechanical CPR was initiated and ventilation was either provided by means of standard IPPV (RR: 10/min, Vt: 8-9 ml/kg, FiO2: 1,0, PEEP: 5 mbar), CPAP (O2-Flow: 10 l/min, PEEP: 5 mbar) or ULTVV (RR: 50/min, Vt: 2-3 ml/kg, FiO2: 1,0, PEEP: 5 mbar). Guideline-based advanced life support was applied for a maximum of 4 cycles and animals achieving ROSC were monitored for 6 h before terminating the experiment. Ventilation/perfusion ratios were performed via multiple inert gas elimination, blood gas analyses were taken hourly and extended cardiovascular measurements were collected constantly. Brain and lung tissue samples were taken and analysed for proinflammatory cytokine expression. RESULTS: ULTVV provided sufficient oxygenation and ventilation during CPR while demanding significantly lower respiratory and intrathoracic pressures. V/Q mismatch was significantly decreased and lung injury was mitigated in surviving animals compared to IPPV and CPAP. Additionally, cerebral cytokine expression was dramatically reduced. CONCLUSION: Ultra-low-volume ventilation during CPR in a porcine model is feasible and may provide lung-protective benefits as well as neurological outcome improvement due to lower inflammation. Our results warrant further studies and might eventually lead to new therapeutic options in the resuscitation setting.


Assuntos
Suporte Vital Cardíaco Avançado/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Análise de Variância , Animais , Modelos Animais de Doenças , Humanos , Lesão Pulmonar/prevenção & controle , Masculino , Troca Gasosa Pulmonar/fisiologia , Distribuição Aleatória , Reação em Cadeia da Polimerase em Tempo Real , Suínos , Volume de Ventilação Pulmonar/fisiologia , Resultado do Tratamento
12.
Zhongguo Dang Dai Er Ke Za Zhi ; 20(8): 603-607, 2018 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-30111466

RESUMO

OBJECTIVE: To compare the clinical efficacy of nasal intermittent positive pressure ventilation (NIPPV) and heated humidified high flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) among very low birth weight (VLBW) preterm infants. METHODS: A total of 89 very low birth weight premature infants with respiratory distress syndrome (RDS) who were randomly administered with NIPPV (n=46) and HHHFNC (n=43) as an initial respiratory support. The incidence of initial treatment failure, the usage of pulmonary surfactant (PS), the parameters of respiratory support treatment and the incidence of complications were compared between the two groups. RESULTS: There were no significant differences between the NIPPV and HHHFNC groups in the following items: the rate of intubation within 72 hours, rate of PS use, duration of invasive or non-invasive mechanical ventilation, duration of oxygen therapy, and incidence rates of severe apnea and pneumonia (P>0.05). There were also no significant differences in the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, intracranial hemorrhage, and air leak between the two group (P>0.05). The incidence rate of nose injury in the NIPPV group was higher than that in the HHHFNC group (P<0.05). CONCLUSIONS: As an initial respiratory support for very low birth weight preterm infants with RDS, HHHFNC has a similar clinical effect as NIPPV, suggesting that HHHFNC is a safe and effective clinical option as a non-invasive ventilation treatment.


Assuntos
Ventilação com Pressão Positiva Intermitente/métodos , Ventilação não Invasiva/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Feminino , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Masculino , Ventilação não Invasiva/efeitos adversos , Terapia Respiratória
13.
PLoS One ; 13(8): e0202641, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30118519

RESUMO

BACKGROUND: Effective positive pressure ventilation (PPV) of non-breathing newborns is crucial in facilitating cardio-respiratory adaptation at birth. Identifying predictors of death in newborns receiving PPV is important in order to facilitate preventative strategies. OBJECTIVE: The objective of this study was to determine the perinatal predictors of death including the quality of PPV administered among admitted newborns. METHODS: An observational study of admitted newborns who received PPV after birth was conducted. Research assistants observed all deliveries and recorded perinatal events on data collection forms. Measured heart rate (HR) and ventilation parameters were then compared between newborns who died and survivors. RESULTS: Newborns (n = 232) were studied between October 2014 and November 2016. Newborns who died (n = 53) compared to survivors (n = 179) had more fetal heart rate (FHRT) abnormalities (12/53 vs 19/179; p = 0.03); lower initial HR (<100 beats/minute) at start of PPV (44/48 vs 77/139; p<0.001); and a longer time for HR to increase >100 beats/minute from birth (180 vs 149 seconds; p = 0.07). Newborns who died compared to survivors took longer time (14 vs 4 seconds; p = 0.008) and more inflations (7 vs 3; p = 0.006) to achieve an expired volume (Vt) of 6 ml/kg, respectively. Median delivered Vt during the first 60 seconds of PPV was less in newborns who died compared to survivors (5 vs 6 ml/kg; p = 0.12). Newborns who died proceeded to severe encephalopathy (15/31 vs 1/59; p<0.001) compared to survivors. CONCLUSION: Depressed newborns who proceeded to death compared to survivors, exhibited delayed HR response to PPV which may partly reflect FHRT abnormalities related to interruption of placental blood flow, and/or a timely delay in establishing adequate Vt. Depressed newborns progressed to moderate/severe encephalopathy. Improving FHRT monitoring to identify fetuses at risk for expedited delivery, coupled with optimizing delivery room PPV might decrease mortality in this setting.


Assuntos
Frequência Cardíaca/fisiologia , Recém-Nascido Prematuro/fisiologia , Ventilação com Pressão Positiva Intermitente/métodos , Ressuscitação/métodos , Salas de Parto , Feminino , Hospitais Rurais , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Ventilação com Pressão Positiva Intermitente/efeitos adversos , Gravidez , Respiração , Ressuscitação/efeitos adversos
14.
Pediatr Pulmonol ; 53(9): 1245-1251, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29999596

RESUMO

OBJECTIVE: To compare short-term application of nasal high-frequency oscillatory ventilation (nHFOV) with nasal continuous positive airway pressure (nCPAP). WORKING HYPOTHESIS: nHFOV improves CO2 removal with respect to nCPAP in preterm infants needing noninvasive respiratory support and persistent oxygen supply after the first 72 h of life. STUDY DESIGN: Multicenter non-blinded prospective randomized crossover study. PATIENT SELECTION: Thirty premature infants from eight tertiary neonatal intensive care units, of mean ± SD 26.4 ± 1.8 weeks of gestational age and 921 ± 177 g of birth weight. METHODOLOGY: Infants were randomly allocated in a 1:1 ratio to receive a starting treatment mode of either nCPAP or nHFOV delivered by the ventilator CNO (Medin, Germany), using short binasal prongs of appropriate size. A crossover design with four 1-h treatment periods was used, such that each infant received both treatments twice. The primary outcome was the mean transcutaneous partial pressure of CO2 (TcCO2 ) value during the 2-h cumulative period of nHFOV compared with the 2-h cumulative period of nCPAP. RESULTS: Significantly lower TcCO2 values were observed during nHFOV compared with nCPAP: 47.5 ± 7.6 versus 49.9 ± 7.2 mmHg, respectively, P = 0.0007. A different TcCO2 behavior was found according to the random sequence: in patients starting on nCPAP, TcCO2 significantly decreased from 50.0 ± 8.0 to 46.6 ± 7.5 mmHg during nHFOV (P = 0.001). In patients starting on nHFOV, TcCO2 slightly increased from 48.5 ± 7.8 to 49.9 ± 6.7 mmHg during nCPAP (P = 0.13). CONCLUSIONS: nHFOV delivered through nasal prongs is more effective than nCPAP in improving the elimination of CO2 .


Assuntos
Dióxido de Carbono/química , Pressão Positiva Contínua nas Vias Aéreas/métodos , Ventilação de Alta Frequência , Ventilação com Pressão Positiva Intermitente/métodos , Desmame do Respirador/métodos , Peso ao Nascer , Estudos Cross-Over , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Itália , Lituânia , Masculino , Ventilação não Invasiva/métodos , Nariz/fisiologia , Estudos Prospectivos , Ventiladores Mecânicos
15.
Am J Perinatol ; 35(6): 545-548, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29694993

RESUMO

High-frequency oscillatory ventilation (HFOV) has been proposed as an alternative method of invasive ventilation in immature infants to prevent ventilator lung injury. To better control the size of the high-frequency tidal volume and to prevent large tidal volumes, a new strategy of controlling the tidal volume during HFOV (VThf) has been developed, HFOV-volume guarantee (VG). Data from preclinical, neonatal animal studies in normal and surfactant-depleted lungs have demonstrated the feasibility of this technique to directly control the VThf in the normal compliance and low compliance situations. Different I:E ratios also can modify the effect of CO2 washout during HFOV combined with VG in a different way as without the VG modality. Finally, clinical use of this technique in newborn infants has demonstrated the possibility of using very high frequency combined with constant very low VThf to decrease the risk of lung trauma related to the ventilator.


Assuntos
Ventilação de Alta Frequência/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Volume de Ventilação Pulmonar , Animais , Animais Recém-Nascidos , Modelos Animais de Doenças , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Pulmão/irrigação sanguínea , Pulmão/fisiopatologia , Troca Gasosa Pulmonar
16.
Semin Fetal Neonatal Med ; 23(5): 340-346, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29705089

RESUMO

Lung aeration is the critical first step that triggers the transition from fetal to postnatal cardiopulmonary physiology after birth. When an infant is apneic or does not breathe sufficiently, intervention is needed to support this transition. Effective ventilation is therefore the cornerstone of neonatal resuscitation. In this article, we review the physiology of cardiopulmonary transition at birth, with particular attention to factors the caregiver should consider when providing ventilation. We then summarize the available clinical evidence for strategies to monitor and perform positive pressure ventilation in the delivery room setting.


Assuntos
Salas de Parto , Ventilação com Pressão Positiva Intermitente/métodos , Respiração , Ressuscitação/métodos , Feminino , Humanos , Recém-Nascido , Gravidez
17.
BMJ Case Rep ; 20182018 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-29599384

RESUMO

Gastric pneumatosisis a very rare site of pneumatosis intestinalis (PI), and we report this finding in a preterm female infant with cyanotic congenital heart disease. The infant was stable initially on nasal intermittent mandatory ventilation; however, torrential pulmonary flow through a large patent ductus arteriosus prompted closure using oral ibuprofen. After an episode of haematochezia, she developed PI, affecting mainly the gastric wall and small intestine with portal venous gas. Her bowel movements were regular, with no abdominal distension or significant gastric aspirates. She was haemodynamically stable with negative infective markers. Management consisted of endotracheal intubation and ventilation, gastric decompression and broad-spectrum antibiotics. Both the gastric and intestinal pneumatosis resolved within 24 hours and she made an uneventful recovery. If PI is not due to necrotising enterocolitis, enteral nutrition can be initiated early and prolonged course of broad-spectrum antibiotics could have been avoided.


Assuntos
Antibacterianos/uso terapêutico , Enterocolite Necrosante , Recém-Nascido Prematuro , Ventilação com Pressão Positiva Intermitente/métodos , Intubação Intratraqueal/métodos , Pneumatose Cistoide Intestinal/terapia , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Intestinos/diagnóstico por imagem , Resultado do Tratamento
18.
BMJ Case Rep ; 20182018 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-29374637

RESUMO

(Un)anticipated difficult airway remains a challenge in anaesthesia. Percutaneous transtracheal jet ventilation has been shown to be an adequate technique for temporary oxygenation and ventilation and has been described as an acknowledged method in emergency settings of an unanticipated difficult airway. These emergency settings can be considered as low incidence high-risk situations. Both technical and non-technical skills should be trained regularly as education and simulation continues to play an important factor in patient safety. Furthermore, postoperative laryngeal oedema due to altered lymphatic drainage patterns must be considered as a possible mechanism of an upper airway obstruction in combination with a history of neck dissection and radiotherapy.


Assuntos
Obstrução das Vias Respiratórias/terapia , Reanimação Cardiopulmonar/métodos , Hipóxia/terapia , Ventilação com Pressão Positiva Intermitente/métodos , Edema Laríngeo/terapia , Obstrução das Vias Respiratórias/etiologia , Feminino , Humanos , Hipóxia/etiologia , Intubação Intratraqueal/efeitos adversos , Edema Laríngeo/etiologia , Pessoa de Meia-Idade
19.
Eur J Anaesthesiol ; 35(4): 307-314, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29303905

RESUMO

BACKGROUND: Pressure-controlled inverse inspiratory to expiratory ratio ventilation (PC-IRV) is thought to be beneficial for reducing the dead space volume. OBJECTIVE: To investigate the effects of PC-IRV on the components of dead space during robot-assisted laparoscopic radical prostatectomy (RLRP). DESIGN: A randomised crossover study of three different ventilator modes. SETTING: A single university hospital from September 2014 to April 2015. PATIENTS: Twenty consecutive study participants undergoing RLRP. INTERVENTIONS: Patients were ventilated sequentially with three different modes in random order for 30 min: volume control ventilation (VCV; inspiratory to expiratory ratio 0.5), pressure control ventilation (PCV; inspiratory to expiratory ratio 0.5) and PC-IRV. Inverse inspiratory to expiratory ratio was adjusted individually by observing the expiratory flow-time wave to prevent the risk of dynamic pulmonary hyperinflation. MAIN OUTCOME MEASURES: The primary outcome included physiological dead space (VDphys), airway dead space (VDaw), alveolar dead space (VDalv) and shunt dead space (VDshunt). VDphys was calculated by Enghoff's method. We also analysed respiratory dead space (VDresp) and VDaw using a novel analytical method. Then, VDalv and VDshunt were calculated by VDalv = VDresp - VDaw and VDshunt = VDphys - VDresp, respectively. RESULTS: The VDphys/expired tidal volume (VTE) ratio in PC-IRV (29.2 ±â€Š4.7%) was significantly reduced compared with that in VCV (43 ±â€Š8.5%) and in PCV (35.9 ±â€Š3.9%). The VDshunt/VTE in PC-IRV was significantly smaller than that in VCV and PCV. VDaw/VTE in PC-IRV was also significantly smaller than that in VCV but not that in PCV. There was no significant change in VDalv/VTE. CONCLUSION: PC-IRV with the inspiratory to expiratory ratio individually adjusted by the expiratory flow-time wave decreased VDphys/VTE in patients undergoing RLRP. TRIAL REGISTRATION: University Hospital Medical Information Network in Japan 000014004.


Assuntos
Expiração/fisiologia , Inalação/fisiologia , Laparoscopia/métodos , Prostatectomia/métodos , Respiração Artificial/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Estudos Cross-Over , Humanos , Ventilação com Pressão Positiva Intermitente/métodos , Ventilação com Pressão Positiva Intermitente/tendências , Laparoscopia/tendências , Masculino , Respiração com Pressão Positiva/métodos , Respiração com Pressão Positiva/tendências , Prostatectomia/tendências , Respiração Artificial/tendências , Procedimentos Cirúrgicos Robóticos/tendências , Volume de Ventilação Pulmonar/fisiologia
20.
J Perinatol ; 38(1): 59-63, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29072677

RESUMO

OBJECTIVE: Examine respiratory severity scores (RSS) (mean airway pressure × fraction of inspired oxygen) and resting energy expenditure (REE) on neurally adjusted ventilatory assist (NAVA) compared with synchronized intermittent mandatory ventilation with pressure controlled and supported breath (SIMV (PC)PS). STUDY DESIGN: A randomized, crossover trial in a level IV neonatal intensive care unit. Twenty-four patients were ventilated with NAVA or SIMV (PC) PS for 12 h and then crossed over to the alternative mode for 12 h. The primary outcome (RSS) and additional secondary respiratory outcomes were analyzed. RESULTS: RSS and measured REE were not different between modes. On NAVA, peak inspiratory pressures were lower (17.8 vs 19.9 cmH2O (P<0.05)) without higher oxygen requirements. Respiratory rates were higher on NAVA (52 vs 39 (P<0.05)), estimated work of breathing (WOB) (0.01 vs 0.04 J l-1 (P<0.05)) was improved. CONCLUSION: NAVA mode can be safe without increase in RSS or REE. Although respiratory rates were higher, this was offset by lower peak inspiratory pressures and WOB during NAVA.


Assuntos
Metabolismo Energético/fisiologia , Suporte Ventilatório Interativo/métodos , Ventilação com Pressão Positiva Intermitente/métodos , Insuficiência Respiratória/terapia , Estudos Cross-Over , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Masculino , Missouri , Oxigênio/sangue , Estudos Prospectivos , Testes de Função Respiratória , Taxa Respiratória , Índice de Gravidade de Doença
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