ABSTRACT
PURPOSE: High flow rate (FR) and pressure limit (PL) strategy with time-cycled pressure-limited (TCPL) ventilator is employed routinely in the neonates. Theoretical basis of this strategy is the two-compartment theory that the lung with acute respiratory failure consists of units with different compliance and resistance. But such constant pressure strategy has the risk of ventilator induced lung injury. We compared the ventilatory indices and clinical outcomes of two different strategies, high FR-constant pressure and low FR-constant FR in the ventilator care of the neonates with acute respiratory failure. METHODS: For the neonates born in our hospital and treated with mechanical ventilation from March to August in 1997, two different ventilator strategies were employed randomly with flow control ventilator. In the high-FR group, the FR was fixed at 10 L/ min and the PL was adjusted according to the arterial blood gas analysis (ABGA) results. In the low-FR group, the FR was adjusted to 10 mL/kg of tidal volume. Sixty neonates were enrolled, 32 in high-FR and 28 in low-FR group. Ventilatory indices and clinical outcomes were statistically cornpared in the two groups. RESULTS: Perinatal factors were not different in the two groups. Initial ventilator settings, ABGA results and ventilatory indices were not different. The tidal volume, fraction of inspired oxygen, peak inspired pressure and oxygenation index were higher and dynamic compliance was lower in the high-FR group compared to the low-FR group after 3 to 72 hours of ventilator care. In clinical outcomes, incidences of pulmonary interstitial emphysema, pneumothorax and chronic lung disease were significantly lower in the low-FR group. CONCLUSION: Low-FR with constant FR strategy resulted in better clinical outcomes in the ventilator care of neonates. We conclude that constant FR strategy prevents damage of the better compliant lung units and decreases the incidence of acute and chronic complications of ventilator care.
Subject(s)
Humans , Infant, Newborn , Blood Gas Analysis , Compliance , Emphysema , Incidence , Lung , Lung Diseases , Oxygen , Pneumothorax , Respiration, Artificial , Respiratory Insufficiency , Tidal Volume , Ventilator-Induced Lung Injury , Ventilators, MechanicalABSTRACT
PURPOSE: This study was aimed to assess the ability of CRIB score as a prognostic indicator in the very low birth weight infants (VLBWI) compared with gestational age and birth weight. METHODS: The medical records of 85 newborns <1,500 g of birth weight were reviewed retrospectively. CRIB score was calculated from six factors (birth weight, gestational age, the presence of congenital malformation, maximum base excess, minimum and maximum appropriate inspired oxygen concentration in the first 12 hours). Neurological rnorbidities such as intraventricular hemorrhage (IVH), increased periventricular echogenicity (PVE), periventricular leukomalacia (PVL) were evaluated. RESULTS: The mean birth weight was 1,152229 g, average gestational age 293.8 weeks, average CRIB scores 5.3+/-4.14 (range 0-16). Mortality rate was 32% (27/85). Neurological morbidities were detected as IVH over grade II in 35 (41%), as increased PVE in 34 (40%) and as PVL in 9 (11%). CRIB score showed significant positive relation with themortality (P<0.05), but not with IVH, PVE, and PVL. CRIB score was a little better for the prediction of mortality than birth weight and gestational age without statistical significance (ROC of 0.784 with CRIB score, 0.708 with birth weight, 0.762 with gestational age). CRIB score was as good for the prediction of neurological morbidity as birth weight and gestational age. CONCLUSION: This study revealed that CRIB score is a useful method to predict the mortality of VLBWI. It is necessary to reevaluate the usefulness of CRIB score with a larger number of VLBWI in the future.
Subject(s)
Humans , Infant , Infant, Newborn , Birth Weight , Gestational Age , Hemorrhage , Infant Equipment , Infant, Very Low Birth Weight , Leukomalacia, Periventricular , Medical Records , Mortality , Oxygen , Retrospective StudiesABSTRACT
PURPOSE: Factors affecting the response to surfactant replacement therapy are considered as types of surfactant, and strategies of treatment including prophylactic vs rescue therapy, single vs multiple doses, methods of mechanical ventilation, and modes of surfactant delivery. Among those factors, response to surfactant replacement therapy according to the modes of surfactant delivery was rarely studied in the world. In preterm infants with RDS, we studied the efficacy and adverse effects of surfactant replacernent therapy according to the differences in the modes of surfactant delivery. METHOD: Preterm infant weighing 500-2,500g with RDS who required assisted ventilation were divided into two groups. One group is as follows five fractional doses with five positional changes after removal from ventilator by feeding tube technique. The other group is as follows; two fractional doses with two positional changes by side-port adaptor technique. Of the 30 infants enrolled, 15 were randomly assigned to each group. We compared the respiratory indices, chest radiologic response, clinical outcome after surfactant replacement, and adverse effects during dosing procedure. RESULT: There were no diffrences of patient profile between two groups. There were significant improvernent in FiO2, a/APO2, MAP, OI, and chest radiologic response following surfactant replacement therapy in both groups. No significant differences were noted in the adverse effects during dosing procedure and incidence of complication. CONCLUSION: In initial phase of RDS treatment with surfactant replacement therapy, two fractional doses with two positional changes by side-port adaptor technique improve respiratory indices, radiologic response without dernonstrable harmful effects as five fractional doses with five positional changes after removal from ventilator by feeding tube technique, however two fractional dosing procedure is more recommendable because of #more simple and convenient procedure.