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Mechanical Ventilation

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https://www.readbyqxmd.com/read/30513521/nasal-high-flow-therapy-as-primary-respiratory-support-for-preterm-infants-without-the-need-for-rescue-with-nasal-continuous-positive-airway-pressure
#1
Sanja Zivanovic, Alexandra Scrivens, Raffaella Panza, Peter Reynolds, Nicola Laforgia, Kevin N Ives, Charles C Roehr
AIM: To evaluate the effectiveness of nasal high-flow therapy (nHFT) as primary respiratory support for preterm infants with respiratory distress syndrome (RDS) in two tertiary neonatal units. METHODS: A retrospective outcome analysis of initial respiratory support strategies was performed in two tertiary neonatal units in the UK: John Radcliffe Hospital (JRH), Oxford and St Peter's Hospital (SPH), Chertsey. Infants born between 28+0 and 36+6 weeks gestational age (GA) between May 2013 and June 2015 were included...
December 4, 2018: Neonatology
https://www.readbyqxmd.com/read/30496228/vitamin-a-to-prevent-bronchopulmonary-dysplasia-in-extremely-low-birth-weight-infants-a-systematic-review-and-meta-analysis
#2
Shunsuke Araki, Shin Kato, Fumihiko Namba, Erika Ota
BACKGROUND: Vitamin A (VA) supplementation reduces the risk of developing bronchopulmonary dysplasia (BPD). However, a previous meta-analysis showed that VA had minimal efficacy for preventing BPD in very low birth weight infants (VLBWIs). AIMS: To elucidate the effects of VA supplementation for BPD prevention in extremely low birth weight infants (ELBWIs). STUDY DESIGN: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
2018: PloS One
https://www.readbyqxmd.com/read/30278459/comparison-of-bubble-cpap-devices-using-ram-cannula-for-extubation-failure-in-very-low-birth-weight-infants-randomized-and-cohort-studies
#3
Colleen C Claassen, Noah H Hillman, Kimberly Brown, Howard L Williams, Marya L Strand
INTRODUCTION: Bubble continuous positive airway pressure (bCPAP) generates a variable pressure due to bubble size and frequency, and these pressure oscillations may contribute to lung recruitment and gas exchange. Single-outlet bCPAP devices generate larger pressure fluctuation than bCPAP devices with diffusers, but clinical efficacy is unclear. Our hypothesis was that a single-outlet bCPAP device (B&B Bubbler©) would decrease extubation failure and improve oxygenation compared with a bCPAP device with a diffuser (BabiPlus©)...
October 2, 2018: Neonatology
https://www.readbyqxmd.com/read/30049727/supporting-breathing-of-preterm-infants-at-birth-a-narrative-review
#4
REVIEW
Tessa Martherus, André Oberthuer, Janneke Dekker, Stuart B Hooper, Erin V McGillick, Angela Kribs, Arjan B Te Pas
Most very preterm infants have difficulty aerating their lungs and require respiratory support at birth. Currently in clinical practice, non-invasive ventilation in the form of continuous positive airway pressure (CPAP) and positive pressure ventilation (PPV) is applied via facemask. As most very preterm infants breathe weakly and unnoticed at birth, PPV is often administered. PPV is, however, frequently ineffective due to pressure settings, mask leak and airway obstruction. Meanwhile, high positive inspiratory pressures and spontaneous breathing coinciding with inflations can generate high tidal volumes...
July 26, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/30068669/sedation-during-minimal-invasive-surfactant-therapy-a-randomised-controlled-trial
#5
Janneke Dekker, Enrico Lopriore, Henriëtte A van Zanten, Ratna N G B Tan, Stuart B Hooper, Arjan B Te Pas
BACKGROUND AND AIMS: Although sedation for endotracheal intubation of infants is widely adopted, there is no consensus whether sedation should be used for minimal invasive surfactant therapy (MIST). We compared, in a randomised controlled setting, the level of stress and comfort of preterm infants during MIST with and without receiving low-dose sedation. METHODS: Infants between 26 and 36 weeks gestational age were randomised to receive either low-dose sedation (1 mg/kg propofol intravenous) or no premedication during MIST procedure...
August 1, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29999603/sustained-lung-inflation-at-birth-via-short-binasal-prong-in-very-low-birth-weight-preterm-infants-a-retrospective-study
#6
Mehmet Buyuktiryaki, Hayriye G Kanmaz, Nilufer Okur, Handan Bezirganoglu, Buse Ozer Bekmez, Gulsum Kadioglu Simsek, Fuat E Canpolat, Suna S Oguz, Cuneyt Tayman
BACKGROUND AND OBJECTIVES: It is believed, that sustained lung inflation (SLI) at birth in preterm infants reduces the need for mechanical ventilation (MV) and improves respiratory outcomes. The aim of this study was to compare need for MV in preterm infants at high risk for respiratory distress syndrome (RDS) after prophylactic SLI via short binasal prongs at birth combined with early nasal continuous positive airway pressure (nCPAP) versus nCPAP alone. METHODS: Medical records of infants born at 260/7 to 296/7 weeks gestation through 2015 and 2017 were retrospectively assessed...
October 2018: Pediatric Pulmonology
https://www.readbyqxmd.com/read/29797429/factors-contributing-to-the-failure-of-humidified-high-flow-nasal-cannulae
#7
Sophia Teoh, Elizabeth Clyde, Theodore Dassios, Anne Greenough
No abstract text is available yet for this article.
October 2018: Acta Paediatrica
https://www.readbyqxmd.com/read/29461885/physiologic-basis-of-mechanical-ventilation
#8
Martin J Tobin
The primary purpose of mechanical ventilation is to decrease work of breathing. Achieving this goal requires that cycling of the ventilator be carefully aligned with the intrinsic rhythm of a patient's respiratory center output. Problems arise at the point of ventilator triggering, post-trigger inflation, and inspiration-expiration switchover. Careful, iterative adjustments of ventilator settings are required to minimize work of breathing. Use of protocols for the selection of ventilator settings can lead to complications (including alveolar overdistention) and risk of death...
February 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29705089/effective-ventilation-the-most-critical-intervention-for-successful-delivery-room-resuscitation
#9
REVIEW
Elizabeth E Foglia, Arjan B Te Pas
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...
October 2018: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29694993/new-ventilator-strategies-high-frequency-oscillatory-ventilation-combined-with-volume-guarantee
#10
M Sánchez-Luna, N González-Pacheco, J Belik, M Santos, F Tendillo
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...
May 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29437799/high-versus-standard-dose-caffeine-for-apnoea-a-systematic-review
#11
REVIEW
Roos Vliegenthart, Martijn Miedema, Gerard J Hutten, Anton H van Kaam, Wes Onland
BACKGROUND: Placebo-controlled trials have shown that caffeine is highly effective in treating apnoea of prematurity and reduces the risk of bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI). OBJECTIVE: To identify, appraise and summarise studies investigating the modulating effect of different caffeine dosages. METHODS: A systematic review identified all randomised controlled trials (RCTs) comparing a high versus a standard caffeine treatment regimen in infants with a gestational age <32 weeks, by searching the main electronic databases and abstracts of the Pediatric Academic Societies...
November 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29393237/high-flow-nasal-cannula-versus-nasal-continuous-positive-airway-pressure-for-primary-respiratory-support-in-preterm-infants-with-respiratory-distress-a-randomized-controlled-trial
#12
Srinivas Murki, Jayesh Singh, Chiragkumar Khant, Swarup Kumar Dash, Tejo Pratap Oleti, Percy Joy, Nandkishor S Kabra
BACKGROUND: Nasal continuous positive airway pressure (nCPAP) is the standard noninvasive respiratory support for newborns with respiratory distress. Evidence for high-flow nasal cannula (HFNC) as an alternative mode of respiratory support is inconclusive. OBJECTIVE: The aim of this work was to evaluate whether HFNC is not inferior to nCPAP in reducing the need for higher respiratory support in the first 72 h of life when applied as a noninvasive respiratory support mode for preterm neonates with respiratory distress...
2018: Neonatology
https://www.readbyqxmd.com/read/29305407/volume-targeting-levels-and-work-of-breathing-in-infants-with-evolving-or-established-bronchopulmonary-dysplasia
#13
Katie Hunt, Theodore Dassios, Kamal Ali, Anne Greenough
OBJECTIVES: To assess the work of breathing at different levels of volume targeting in prematurely born infants with evolving or established bronchopulmonary dysplasia (BPD). DESIGN: Randomised crossover study. SETTING: Tertiary neonatal intensive care unit. PATIENTS: Eighteen infants born at <32 weeks gestation who remained ventilated at or beyond 1 week after birth, that is, they had evolving or established BPD...
January 5, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29275926/variation-in-positive-end-expiratory-pressure-levels-for-mechanically-ventilated-extremely-low-birth-weight-infants
#14
Nicolas A Bamat, James P Guevara, Matthew Bryan, Robin S Roberts, Bradley A Yoder, Brigitte Lemyre, Aaron Chiu, David Millar, Haresh Kirpalani
OBJECTIVE: To test the hypothesis that significant positive end-expiratory pressure (PEEP) level variation exists between neonatal centers. STUDY DESIGN: We performed a secondary analysis cohort study of the Nasal Intermittent Positive-Pressure Ventilation trial. Our study population was extremely low birth weight infants requiring mechanical ventilation within 28 days of life. The exposure was neonatal center; 34 international centers participated in the trial...
March 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/28965435/early-rescue-neopuff-for-infants-with-transient-tachypnea-of-newborn-a-randomized-controlled-trial
#15
Amani Mahmoud Osman, Rania Ali El-Farrash, Enas Hussein Mohammed
OBJECTIVE: To examine the efficacy of early continuous positive airway pressure (CPAP), delivered using a T-piece-based infant resuscitator (Neopuff) via a face mask, in reducing the severity and duration of transient tachypnea of the newborn (TTN) as well as testing a hypothesis suggesting that rapid clearance of fetal lung fluid to the circulation via CPAP would increase plasma B-type natriuretic peptide (BNP). METHODS: A randomized controlled trial (NCT01859533) was conducted on 64 late preterm/term neonates, delivered by cesarean section and presented by respiratory distress shortly after birth...
October 16, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28146296/nasal-intermittent-positive-pressure-ventilation-nippv-versus-nasal-continuous-positive-airway-pressure-ncpap-for-preterm-neonates-after-extubation
#16
REVIEW
Brigitte Lemyre, Peter G Davis, Antonio G De Paoli, Haresh Kirpalani
BACKGROUND: Previous randomised trials and meta-analyses have shown that nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after extubation. However, this treatment sometimes 'fails' in infants, and they may require endotracheal re-intubation with its attendant risks and expense. Nasal intermittent positive pressure ventilation (NIPPV) can augment NCPAP by delivering ventilator breaths via nasal prongs. Older children and adults with chronic respiratory failure benefit from NIPPV, and the technique has been applied to neonates...
February 1, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28476473/decrease-in-delivery-room-intubation-rates-after-use-of-nasal-intermittent-positive-pressure-ventilation-in-the-delivery-room-for-resuscitation-of-very-low-birth-weight-infants
#17
Manoj Biniwale, Fiona Wertheimer
BACKGROUND: The literature supports minimizing duration of invasive ventilation to decrease lung injury in premature infants. Neonatal Resuscitation Program recommended use of non-invasive ventilation (NIV) in delivery room for infants requiring prolonged respiratory support. OBJECTIVE: To evaluate the impact of implementation of non-invasive ventilation (NIV) using nasal intermittent positive pressure ventilation (NIPPV) for resuscitation in very low birth infants...
July 2017: Resuscitation
https://www.readbyqxmd.com/read/27976361/early-nasal-intermittent-positive-pressure-ventilation-nippv-versus-early-nasal-continuous-positive-airway-pressure-ncpap-for-preterm-infants
#18
REVIEW
Brigitte Lemyre, Matthew Laughon, Carl Bose, Peter G Davis
BACKGROUND: Nasal continuous positive airway pressure (NCPAP) is a strategy for maintaining positive airway pressure throughout the respiratory cycle through the application of bias flow of respiratory gas to an apparatus attached to the nose. Treatment with NCPAP is associated with decreased risk of mechanical ventilation and might be effective in reducing chronic lung disease. Nasal intermittent positive pressure ventilation (NIPPV) is a form of noninvasive ventilation during which patients are exposed intermittently to higher levels of airway pressure, along with NCPAP through the same nasal device...
December 15, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28709948/mechanical-ventilation-strategies
#19
REVIEW
Martin Keszler
Although only a small proportion of full term and late preterm infants require invasive respiratory support, they are not immune from ventilator-associated lung injury. The process of lung damage from mechanical ventilation is multifactorial and cannot be linked to any single variable. Atelectrauma and volutrauma have been identified as the most important and potentially preventable elements of lung injury. Respiratory support strategies for full term and late preterm infants have not been as thoroughly studied as those for preterm infants; consequently, a strong evidence base on which to make recommendations is lacking...
August 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28665065/prophylactic-versus-early-rescue-surfactant-treatment-in-preterm-infants-born-at-less-than-30-weeks-gestation-or-with-birth-weight-less-than-or-equal-1-250-grams
#20
Jiyoung Chun, Se In Sung, Yo Han Ho, Jisook Kim, Ga Young Park, Shin Ae Yoon, So Yoon Ahn, Yun Sil Chang, Won Soon Park
Prophylactic surfactant is known to be effective to reduce chronic lung disease in preterm infants compared with rescue surfactant treatment. In Korea, early prophylactic surfactant therapy was introduced in 2011. However, recently, the increased utilization of antenatal steroids and early stabilization through continuous positive airway pressure (CPAP) in the delivery room may have changed the risks and benefits of prophylactic surfactant therapy of infants at high risk of respiratory distress syndrome (RDS)...
August 2017: Journal of Korean Medical Science
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