ABSTRACT
Objective:To study the early use of inhaled nitric oxide (iNO) as a rescue therapy in extremely premature infants (EPIs) with refractory hypoxic respiratory failure (HRF).Methods:Between January 2021 and December 2021, EPIs with refractory HRF receiving iNO within the first week of life in our NICU were enrolled. Their clinical characteristics and outcomes were retrospectively analyzed.Results:A total of 11 EPIs were included with 5 males and 6 females. The median gestational age (GA) was 24(22.6, 25.2) weeks. The median birth weight (BW) was 580(490, 770) g. The most common primary diagnoses were moderate/severe respiratory distress syndrome (RDS) (5/11) and early-onset sepsis (3/11). The median age starting iNO therapy was 6.5(4.5, 34.0)h and the median duration of iNO was 24(12, 36)h. The median iNO starting dose was 5(5, 8) ppm and the therapeutic range was 5-20 ppm. Therapeutic efficacy was defined as ≥30% FiO 2 reduction after 6 h of iNO treatment. The treatment was effective in 8 cases. The oxygenation index (OI) decreased more than 10% from baseline 1 h after initiation in 9 patients and in all 11 patients after 12 h of iNO. The reduction of OI was more prominent in EPIs with a higher OI at baseline. Of the 11 patients, 8 survived, 1 died and 2 abandoned further treatments. Conclusions:As an early rescue therapy for EPIs with refractory HRF, iNO can improve oxygenation without obvious short-term adverse effects.
ABSTRACT
Resumen: La pandemia por coronavirus tipo 2 o SARS-CoV-2 tiene en jaque al sistema sanitario mundial dada su alta tasa de contagio; ha hecho colapsar todos los sistemas de salud y ha puesto en evidencia la escasez de recursos como los elementos de protección y la cantidad insuficiente de ventiladores en relación con el número de pacientes con falla respiratoria aguda hipoxémica. Por estas razones, se ha tenido que recurrir a diferentes opciones, una de ellas la cánula de alto flujo, que permite administrar oxígeno a alto flujo a los pacientes con hipoxemia severa. Durante la pandemia por COVID-19, se ha generado la inquietud acerca de que este dispositivo, como todos los dispositivos que permiten la administración de oxígeno, produce gran dispersión de aerosoles y la posibilidad de contagio del personal de la salud, lo cual ha llevado a desestimar su uso y utilizar de manera casi exclusiva la cánula nasal convencional y la ventilación mecánica en sujetos infectados. De manera que en este trabajo, se realizó una revisión de la literatura que recoge los mecanismos de acción, su seguridad para el personal de salud y las indicaciones del uso de la cánula nasal de alto flujo en los pacientes infectados por COVID-19 así como sus ventajas; entre ellas, ser dispositivo ahorrador de ventiladores mecánicos, lo que puede ser muy útil en el manejo de los pacientes en caso de un pico epidémico en Colombia.
Abstract: The coronavirus type 2 or SARS-CoV-2 pandemic has held a threat over the world health system due to its high transmission rate. It has made all health systems collapse and has made evident the lack of resources such as personal protection elements and the insufficient number of ventilators for the number of patients with acute hypoxic respiratory failure. Due to his reasons, many options have been used as an alternative, being the high-flow nasal cannula one of them since it allows administering high-flow oxygen to patients with severe hypoxemia. During the COVID-19 epidemic, a concern has raised regarding this device as well as all devices used to supply oxygen to patients since they produce great dispersion of aerosols and the possibility of transmission to clinicians and staff. This has led to reject its use and give almost exclusive preference to the use of conventional cannula and mechanical ventilators with infected patients. Therefore, this study reviews the literature dealing with the high-flow nasal cannula action mechanisms, its safety for health workers and its indications for patients infected with COVID-19, as well as its advantages; amongst them, being a device that prevents the use of mechanical ventilators, which can be useful when managing patients in case of an epidemiological peak in Colombia.
Resumo: A pandemia pelo coronavírus tipo 2, SARS-CoV-2, põe em xeque o sistema sanitário mundial tendo em vista sua alta taxa de contágio. Além disso, tem feito colapsar todos os sistemas de saúde e evidenciado a escassez de recursos como os elementos de proteção e a quantidade insuficiente de ventiladores para o número de pacientes com insuficiência respiratória aguda hipoxêmica. Por essas razões, recorre-se a diferentes opções, uma delas a cânula de alto fluxo, que permite administrar oxigénio a alto fluxo aos pacientes com hipoxemia severa. Durante a pandemia pela COVID-19, muitas dúvidas são geradas sobre esse dispositivo, como todos os dispositivos que permitem o manejo do oxigênio, produz grande dispersão de aerossóis e a possibilidade de contágio da equipe de saúde, o que tem levado a desestimar seu uso e a utilizar de maneira quase exclusiva a cânula nasal convencional e a ventilação mecânica em sujeitos infectados. Assim, neste trabalho, foi realizada uma revisão da literatura que coleta os mecanismos de ação, sua segurança para a equipe de saúde e as indicações do uso da cânula nasal de alto fluxo nos pacientes com COVID-19, bem como suas vantagens; entre elas, ser dispositivo que dispensa ventiladores mecânicos, o que pode ser muito útil no manejo dos pacientes caso haja um pico epidêmico na Colômbia.
ABSTRACT
Objective@#To investigate the effect of high flow nasal catheter (HFNC) respiratory support flow and temperature on the comfort of patients with acute hypoxemic respiratory failure (AHRF), and the AHRF subgroup with severe hypoxemia (FiO2 ≥ 45%), improve HNFC flow to improve patient comfort.@*Methods@#A prospective, randomized, crossover study of 40 patients with AHRF who underwent HFNC respiratory support (PaO2/FiO2 ≤ 300 + pulmonary infiltration + exclusion of cardiogenic pulmonary edema) was performed to assess patient comfort changes in HFNC flow and temperature changes.@*Results@#When the HFNC flow rate was 30 L/min and 60 L/min, the patient′s comfort at 31 °C was significantly improved (P < 0.01), and the change in flow was not related to patient comfort. In the subgroup of patients with FiO2 ≥ 45%, lower temperature (31 °C) and higher HFNC flow (60 L/min) improved patient comfort (P < 0.01).@*Conclusion@#The temperature of HFNC respiratory support significantly affects the comfort of patients with AHFP. Patients with lower temperature are more comfortable, and comfort is not related to flow. For patients with severe hypoxemia (FiO2 ≥ 45%), high flow rates provide better comfort.
ABSTRACT
Esophageal pressure(Pes)is usually measured via a catheter with an air - filled thin - walled latex balloon inserted nasally or orally. To validate Pes measurement,a dynamic occlusion test measures the ratio of change in Pes to change in Paw during inspiratory efforts against a closed airway. This report summarizes current physiological and technical knowledge on esophageal pressure measurements in patients receiving mechanical ventilation. The respiratory changes in Pes are representative of changes in pleural pressure. The difference between airway pressure(Paw)and Pes is a valid estimate of transpulmonary pressure. Because of the nonuniformity of lesion of pulmonary in patient with acute respiratory distress syndrome,Paw and volume can not represent the stress to expand the pulmonary. How to adjust posi-tive end expiratory pressure(PEEP)is still lack of gold standard. The use of Pes for PEEP titration may help improve oxygenation and compliance,or even has the possibility to improve the patient outcome.
ABSTRACT
Nitric oxide (NO) is a colorless, odorless gas that acts as a potent pulmonary vasodilator. When administered via inhalation, NO rapidly diffuses across the alveolarcapillary membrane and binds to hemoglobin, and thus has little effect on the systemic circulation. NO was approved by the United States Food and Drug Administration (US FDA) for the treatment of hypoxic respiratory failure associated with pulmonary hypertension in 1999. Neonatal hypoxic respiratory failure may be caused by persistent pulmonary hypertension of the newborn and other diseases such as meconium aspiration syndrome, sepsis, birth asphyxia, and respiratory distress syndrome that contribute to pulmonary arterial hypertension. Inhaled NO is the only approved treatment in term and late preterm (>34 weeks) neonates with hypoxic respiratory failure associated with pulmonary hypertension, and it reduces the need for extracorporeal membrane oxygenation. The present article will review the clinical indications for US FDA-approved inhaled NO therapy according to evidence-based clinical studies.
Subject(s)
Female , Humans , Infant, Newborn , Asphyxia , Extracorporeal Membrane Oxygenation , Hypertension , Hypertension, Pulmonary , Inhalation , Meconium Aspiration Syndrome , Membranes , Nitric Oxide , Parturition , Persistent Fetal Circulation Syndrome , Respiratory Insufficiency , Sepsis , United States Food and Drug AdministrationABSTRACT
Objective To study the clinic effect and safety of inhaled nitric oxide for the neonates with hypoxic respiratory failure. Methods A total of 21 neonates with hypoxic respiratory failure were trea-ted with nitric oxide inhalation after ineffective treatment of conventional mechanical ventilation. The values of mean airway pressure( MAP) ,oxygenation index( OI) ,mean blood pressure and saturation of blood oxy-gen percutem( TcSaO2 ) were detected before and after nitric oxide inhalation. Meanwhile,the values of coag-ulation function,nitrogen dioxide concentration and methaemoglobin were monitored. Results The lung oxy-genation of 21 cases were significantly improved in 48 hours after nitric oxide inhalation,OI declined from 26. 600 ±4. 169 to 7. 500 ±1. 716,MAP decreased from(15. 100 ±2. 132)cmH2O(1 cmH2O=0. 098 kPa) to (8. 000 ± 0. 816) cmH2O,which all had statistical differences(P <0. 01). The monitoring of coagulation function was in the normal range. The levels of methaemoglobin were less than 3% and nitrogen dioxide less than 1 × 10 -6 . In this study,18 neonates survived,2 neonates died and 1 neonate gave up treatment. Conclu-sion Inhaled nitric oxide early can improve oxygenation effectively for neonates with hypoxic respiratory failure without obvious side-effect. However,it is not yet clear for its long-term prognosis and whether there is influence development of the nervous system.