Evaluation of volume-targeted versus pressure-limited ventilation for Preterm Neonates with respiratory distress

Objectives: To evaluate the efficiency of volume targeted versus pressure-limited ventilation for preterm infants with respiratory distress

Methods: 60 newborn infants with gestational age 28-34 weeks in the NICU at Alexandria University Children's Hospital randomly divided in to 2 groups ventilated with either volume targeted ventilation [VTV] or pressure limited time cycled ventilation [PLV] as primary mode or secondary to failure of NCPAP using SLE 4000 or 5000 ventilators

Results: The demographic and clinical characteristics, values of tidal volume [VT], peak inspiratory pressure [PIP], mean airway pressure [MAP], fraction of inspired oxygen [Fio2], alveolar arterial oxygen gradient [A-aDo2], carbon dioxide tension, and pH were similar for all participating infants initially. During the follow-up, the PIP, MAP and FIO2 levels were significantly decreasing in the VTV group during the first 48 hrs. Moreover, The VTV group showed significantly lower incidence of hypocarbia and non-permissible hypercarbia. The VTV group showed significantly shorter duration of ventilation. There was no statistical significant difference between both groups as regards IVH, air leaks BPD, PDA or nosocomial infection

Conclusion: The use of VTV achieves adequate gas exchange using lower MAP and with less variability in tidal volume reducing the risk of hypocarbia and non-permissible hypercarbia. The use of VTV also shortens the duration of ventilation in premature infants with respiratory distress

Large incisional hernia repair using polyprulene peritoneal sandwich technique in patients with chroric obstructive pulmonary disease

incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is the best. There are attempts to modify and the techniques of hernia repair aiming at implantation of a smaller mesh that can keep its tensile strength without causing stiffness of the abdominal wall or decreasing its compliance. These attempts may be of a particular significance for patients with incisional hernia who have chronic obstructive pulmonary disease [COPD]. the aim of this study was to analyze mesh-related postoperative pulmonary complications and the short and long-term outcome among COPD patients who underwent incisional hernia repairs using polyprolene peritoneal sandwich technique. between December 1998 to September 2000, 29 elective large incisional hernia using polyprolene peritoneal sandwich technique were performed among COPD patients. Pulmonary function tests were done preoperatively, postoperative pulmonary outcome were correlated to the patients variables. there was no peroperative mortality. Early postoperative surgical complications occurred in 5 patients [17.2%] included, postoperative ileus in 2 patients, major wound infection in 1 patient, minor wound infection in 1 patient and discharging sinus in 1 patient. Postoperative pulmonary complications occurred in 8 patients [27.5%] but all of them were managed conservatively. Recurrence of hernia after follow up for 2 years occurred in I patient [3.4%]. the finding of this study led us to conclude that polyprolene peritoneal sandwich technique could be used as a safe and effective approach in the repair of large incisional hernia in patients with chronic obstructive pulmonary diseases. The advantages of this technique is that the mesh does not come in direct contact with either the abdominal viscera or tissues of the anterior abdominal wall, also there is less dissection in the subcutaneous planes. The lower rates of postoperative surgical and pulmonary complications among these high-risk patients support the advantage of using this technique