Efficacy of noninvasive high-frequency oscillatory ventilation versus nasal intermittent positive pressure ventilation as post-extubation respiratory support in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the efficacy and safety of noninvasive high-frequency oscillatory ventilation (NHFOV) versus nasal intermittent positive pressure ventilation (NIPPV) as post-extubation respiratory support in preterm infants.@*METHODS@#China National Knowledge Infrastructure, Wanfang Data, Chinese Journal Full-text Database, China Biology Medicine disc, PubMed, Web of Science, and the Cochrane Library were searched for articles on NHFOV and NIPPV as post-extubation respiratory support in preterm infants published up to August 31, 2022. RevMan 5.4 software and Stata 17.0 software were used for a Meta analysis to compare related indices between the NHFOV and NIPPV groups, including reintubation rate within 72 hours after extubation, partial pressure of carbon dioxide (PCO2) at 6-24 hours after switch to noninvasive assisted ventilation, and the incidence rates of bronchopulmonary dysplasia (BPD), air leak, nasal damage, periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).@*RESULTS@#A total of 9 randomized controlled trials were included. The Meta analysis showed that compared with the NIPPV group, the NHFOV group had significantly lower reintubation rate within 72 hours after extubation (RR=0.67, 95%CI: 0.52-0.88, P=0.003) and PCO2 at 6-24 hours after switch to noninvasive assisted ventilation (MD=-4.12, 95%CI: -6.12 to -2.13, P<0.001). There was no significant difference between the two groups in the incidence rates of complications such as BPD, air leak, nasal damage, PVL, IVH, and ROP (P>0.05).@*CONCLUSIONS@#Compared with NIPPV, NHFOV can effectively remove CO2 and reduce the risk of reintubation, without increasing the incidence of complications such as BPD, air leak, nasal damage, PVL, and IVH, and therefore, it can be used as a sequential respiratory support mode for preterm infants after extubation.

Effect of the alveolar recruitment manoeuvre on pulmonary complications in the immediate postoperative period of cardiac surgery: preliminary results of a randomised controlled trial / Efeito da manobra de recrutamento alveolar em complicações pulmonares no pós-operatório imediato de cirurgia cardíaca: resultados preliminares de ensaio clínico randomizado

Introducion: given the great variability in ventilation protocols, postoperative management, characteristics of the alveolar recruitment maneuver (ARM) (frequency, duration and intensity) and tolerability in patients undergoing cardiac surgery (CS), this study investigates whether ARM is beneficial in this area. situation in order to standardize its use. Objective: we investigated the effectiveness of ARM against pulmonary complications (PCs) immediately after CS. Methods: this randomised clinical trial included 134 patients aged >18 years who underwent coronary artery bypass graft or valve replacement surgery at our institution between February and September 2019. Participants were allocated to receive standard physiotherapy (control group [CG], n=67) or standard physiotherapy plus ARM (intervention group [IG], n=67). Results: there was no statistically significant difference in the incidence of PCs between the CG and IG groups (p=0.85). ARM did not improve gas exchange or lower total mechanical ventilation time, reintubation requirement, or intensive care unit and hospital stay. Conclusions: prophylactic ARM does not decrease the insufficiency of PCs in the postoperative period of CS, it did not improve gas exchange, nor did it reduce the time of MV. MRA was associated with an increased risk of hemodynamic instability. Patients must be screened before performing ARM.

Introdução: dada a grande variabilidade nos protocolos de ventilação, manejo pós-operatório, características da manobra de recrutamento alveolar (MRA) (frequência, duração e intensidade) e tolerabilidade em pacientes submetidos à cirurgia cardíaca (CC), este estudo investiga se a MRA é benéfica nesta área, a fim de padronizar seu uso. Objetivo: investigou-se a eficácia da MRA contra complicações pulmonares (CPs) imediatamente após a CC. Metodologia: este ensaio clínico randomizado incluiu 134 pacientes com idade > 18 anos submetidos à cirurgia de revascularização do miocárdio ou cirurgia de substituição valvar em nossa instituição entre fevereiro e setembro de 2019. Os participantes foram alocados para receber fisioterapia padrão (grupo controle [GC], n=67) ou fisioterapia padrão com adição da MRA (grupo intervenção [GI], n=67). Resultados: não houve diferença estatisticamente significativa na incidência de CPs entre os grupos GC e GI (p=0,85). A MRA não melhorou as trocas gasosas ou reduziu o tempo total de ventilação mecânica, necessidade de reintubação na unidade de terapia intensiva e internação hospitalar. Conclusão: a MRA profilática não diminui a incidência de CPs no pós-operatório de CC, não melhora as trocas gasosas, nem reduziu o tempo de VM. A MRA foi associada a um risco aumentado de instabilidade hemodinâmica. Os pacientes devem ser avaliados antes de realizar MRA.

Research advances in the methods for weaning from high-frequency oscillatory ventilation in neonates / 中国当代儿科杂志

Neonatal respiratory failure is a serious clinical illness commonly seen in the neonatal intensive care unit (NICU). Although clinicians want to maximize noninvasive respiratory support, some low-birth-weight preterm infants may require invasive respiratory support from the beginning. As an important respiratory management technique for the treatment of respiratory failure, high-frequency oscillatory ventilation (HFOV) allows gas exchange by rapid delivery at a tidal volume lower than or equal to anatomy death volume. Continuous distending pressure was applied to achieve uniform lung expansion, reduce repeated contraction of lung tissue, and exert a protective effect on lung tissue, and so it is preferred by clinicians and has been widely used in clinical practice. However, no consensus has been reached on the methods for weaning from HFOV. This article reviews the methods for weaning from HFOV, so as to provide help for clinical practice.

Clinical efficacy of nasal high-frequency ventilation in treatment of neonatal respiratory distress syndrome: a Meta analysis / 中国当代儿科杂志

OBJECTIVE@#To systematically evaluate the clinical efficacy of nasal high-frequency ventilation (nHFV) in the treatment of neonatal respiratory distress syndrome (NRDS).@*METHODS@#A literature search was performed in PubMed, Cochrane Library, EMBase (Ovid), Chinese Biomedical Literature Database, Chinese Journal Full-text Database, Wanfang Data, and Weipu Data to collect the randomized controlled trials (RCTs) that compared the clinical efficacy of nHFV and nasal continuous positive airway pressure (nCPAP) in the treatment of NRDS. A Meta analysis was performed on the included RCTs using Rev Man 5.3 software after data extraction and quality evaluation by Cochrane 5.1.0.@*RESULTS@#A total of 4 RCTs involving 218 patients were included. The Meta analysis showed that compared with the nCPAP group, the nHFV group had a significantly better treatment outcome (RR=1.73, 95%CI: 1.39-2.15, P<0.00001). There were no significant differences in the incidence rates of intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, necrotizing enterocolitis, pneumothorax and retinopathy of prematurity.@*CONCLUSIONS@#Compared with nCPAP, nHFV has better clinical efficacy in the treatment of NRDS, without increasing the risk of related complications.

Research advances in neonatal nasal intermittent positive pressure ventilation / 中国当代儿科杂志

Nasal intermittent positive pressure ventilation (NIPPV) can augment nasal continuous positive airway pressure (nCPAP) by delivering intermittent positive pressure ventilation in a noninvasive way and can provide a new option for neonatal noninvasive respiratory support. NIPPV has an advantage over nCPAP in primary and post-extubation respiratory support. Moreover, it can reduce severe apnea of prematurity. Synchronized NIPPV has promising application prospects. This review article summarizes the advances in the application of NIPPV in neonatal respiratory support to promote the understanding and standardization of this technique.

Influencia del tiempo inspiratorio prolongado durante la ventilación transoperatoria controlada por presión / The influence of lengthening the inspiration time during pressure-controlled intraoperative ventilation

Introducción: la enfermedad pulmonar obstructiva crónica es la sexta causa de muerte a nivel mundial. La prolongación del tiempo inspiratorio es una práctica con ventajas y desventajas. Objetivo: comparar los beneficios de diferentes tiempos inspiratorios sobre la oxigenación, las presiones en la vía respiratorias y las variaciones hemodinámicas. Métodos: estudio analítico longitudinal prospectivo con un grupo. Universo de 36 pacientes que cumplieron con los criterios de inclusión. Resultados: la media de la edad fue de 70,5 años ± 8,3 años, el 59 por ciento fueron mujeres. El 38,7 por ciento fueron hipertensos, y el 41,2 por ciento cardiópatas. Las presiones pico fueron de 26,6 mbar Ti corto y en el Ti largo 19,1 mbar (t student 1,28). Las medias de las presiones mesetas se comportaron diferentes con Ti corto de 20,6 mbar y Ti largo 19,6 mbar con t student de 0,04. Las medias de las frecuencias respiratorias en el Ti corto fueron de 12,6 resp/min y en el Ti largo 10,7 resp/min con t student fue de 5,92. La relación entre saturación de oxigeno/fracción inspirada de oxigeno en el Ti corto fue de 243 y en el Ti largo 248, pero la t student fue de 5,9. Conclusiones: la prolongación del tiempo inspiratorio durante la ventilación intraoperatoria controlada por presión en pacientes con enfermedad pulmonar obstructiva crónica es ventajosa porque reduce las presiones de la vía respiratoria y mantiene los parámetros de oxigenación y hemodinámicos con relación al tiempo inspiratorio convencional, por lo que pudiera ser una alternativa para el manejo anestésico de estos pacientes(AU)

Introduction: Chronic obstructive pulmonary disease is the sixth leading cause of death worldwide. Lengthening the inspiration time is a practice with advantages and disadvantages. Objective: To compare the benefits of different inspiration times on oxygenation, airway pressures and hemodynamic changes. Methods: Prospective longitudinal analytic study with a group. Sample group of 36 patients who met the inclusion criteria. Results: The mean age was 70.5 years ± 8.3 years, 59 percent were women. 38.7 percent were hypertensive, and 41.2 percent were cardiac patients. The peak pressures were 26.6 mbar in the short Ti and 19.1 mbar in the long Ti (Student's t-distribution was 1.28). The means of the plateau pressure behaved different: with short Ti, 20.6 mbar, and with long Ti, 19.6 mbar, with Student's t-distribution: 0.04. Mean respiratory rates in the short Ti were 12.6 breaths/min and in the long Ti, 10.7 breaths/min, with Student's t-distribution 5.92. The relation between oxygen saturation and fraction of inspired oxygen in the Ti short was 243 and in the long Ti was 248, but the Student's t-distribution was 5.9 t. Conclusions: Lengthened inspiratory time during intraoperative pressure-controlled ventilation in patients with chronic obstructive pulmonary disease is advantageous because it reduces the airway pressure and maintains oxygenation and hemodynamic parameters versus conventional inspiration time, so it could be an alternative for the anesthetic management of these patients(AU)

Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation / Estudo controlado e randomizado entre uso de ventilação positiva intermitente e pressão positiva contínua em vias aéreas em recém-nascidos prematuros após a extubação traqueal

Summary Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV) after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (nCPAP). Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA) ≤ 36 weeks and birth weight (BW) > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6%) presented extubation failure in comparison to 11 (30.5%) of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

Resumo Objetivo: analisar a frequência de falha da extubação em recém-nascidos pré-termo (RNPT) em uso de ventilação mecânica (VM) convencional após a extubação traqueal nos grupos submetidos à ventilação por pressão positiva intermitente por via nasal (nIPPV) e pressão positiva contínua em vias aéreas (nCPAP). Método: foram estudados 72 RNPT portadores de insuficiência respiratória, com idade gestacional (IG) ≤ 36 semanas e peso de nascimento (PN) > 750 g, que necessitaram de entubação traqueal e ventilação mecânica. O estudo foi controlado e randomizado a fim de garantir a aleatoriedade na escolha dos integrantes dos grupos. A randomização foi realizada no momento da extubação por meio de envelopes selados. Falha da extubação foi definida como necessidade de reentubação e ventilação mecânica durante as primeiras 72 horas após a extubação. Resultados: entre os 36 RN randomizados para nIPPV, seis (16,6%) apresentaram falha de extubação em comparação a 11 (30,5%) dos 36 RN randomizados para nCPAP. Não houve diferença estatística entre os dois grupos de estudo em relação a PN, IG, classificação do RN e tempo de VM. A principal causa de falha da extubação foi a ocorrência de apneia. Complicações gastrointestinais e neurológicas não ocorreram nos RNPT participantes do estudo. Conclusão: constatamos que no grupo dos RNPT submetidos à nIPPV, apesar da falha da extubação ser numericamente menor que nos RNPT submetidos à nCPAP, não houve diferença estatisticamente significante entre os dois modos de suporte ventilatório após a extubação.

Impact of respiratory therapy in vital capacity and functionality of patients undergoing abdominal surgery / Impacto da fisioterapia respiratória na capacidade vital e na funcionalidade de pacientes submetidos à cirurgia abdominal

ABSTRACT Objective To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. Methods A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. Results We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (p<0.001) and Ddis (p<0.001) and in the Functional Independence Measure (p<0.001) after respiratory therapy. The vital capacity improvement was not associated with gain of muscle strength. Conclusion Chest therapy, with positive pressure and volumetric incentive spirometer, was effective in improving vital capacity of patients submitted to abdominal surgery.

RESUMO Objetivo Avaliar a capacidade vital comparando duas técnicas de fisioterapia respiratória em pacientes submetidos à cirurgia abdominal. Métodos Estudo prospectivo e randomizado realizado com pacientes admitidos em Unidade de Terapia Intensiva após cirurgia abdominal. Verificamos a capacidade vital, a força muscular por meio da escala do Medical Research Council e funcionalidade pela Medida de Independência Funcional no primeiro momento em que o paciente encontrava-se em respiração espontânea (D1) e na alta da Unidade de Terapia Intensiva (Dalta). Entre D1 e Dalta, foi realizada a fisioterapia respiratória, conforme o grupo randomizado. Resultados Foram incluídos 38 pacientes, sendo 20 randomizados para Grupo Pressão Positiva Intermitente e 18 para o Grupo Incentivador Inspiratório a Volume. A capacidade vital entre o D1 e Dalta do Grupo Pressão Positiva Intermitente não teve ganho significativo (média de 1.410mL±547,2 versus 1.809mL±692,3; p=0,979), assim como no Grupo Incentivador Inspiratório a Volume (1.408,3mL±419,1 versus 1.838,8mL±621,3; p=0,889). Houve melhora significativa da capacidade vital no D1 (p<0,001) e na Dalta (p<0,001) e da Medida de Independência Funcional (p<0,001) após a fisioterapia respiratória. A melhora da capacidade vital não apresentou relação com o ganho da força muscular. Conclusão A fisioterapia respiratória, por meio de pressão positiva ou de incentivador inspiratório a volume, foi eficaz na melhora da capacidade vital em pacientes submetidos à cirurgia abdominal.

Apllication of nasal synchronous intermittent mandatory ventilation in premature infants with severe respiratory distress syndrome after extubation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical efficacy of nasal synchronous intermittent mandatory ventilation (nSIMV) in premature infants with severe respiratory distress syndrome (RDS) after extubation.</p><p><b>METHODS</b>A retrospective analysis on the clinical date of 126 premature infants with severe RDS who were hospitalized in the NICU between January 2013 and May 2015 was performed. Sixty-one premature infants who were hospitalized in the NICU between January 2013 and March 2014 received nasal continuous positive airway pressure (nCPAP) (nCPAP group) and 65 premature infants who were hospitalized in the NICU between April 2014 and May 2015 received nSIMV (nSIMV group). The blood gas analysis indexes, the rate of extubation failure, the causes of extubation failure and the incidence of complications were compared between the two groups.</p><p><b>RESULTS</b>After 4 hours of treatment, the pH value, PaO2, SaO2 and oxygenation index in the nSIMV group were significantly higher than in the nCPAP group (P<0.05), meanwhile, the PaCO2 in the nSIMV group were significantly lower than in the nCPAP group (P<0.05). The rates of extubation failure in the nSIMV and nCPAP groups were 9% (6/65) and 30% (18/61) respectively (P<0.05). The extubation failure in the nSIMV and nCPAP groups was caused by hyoxemia (2% vs 5%; P>0.05), hypercapnia (6% vs 11%; P>0.05) and apnea (2% vs 13%; P<0.05). There were no differences in respirator support time, full enteral feeding time, the time to regain birth weight and the length of hospitalization between two groups (P>0.05). After treatment, the incidence of abdominal distension in the nSIMV group was significantly lower than in the nCPAP group (9% vs 30%; P<0.05) and there were no differences in the incidences of feeding intolerance, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity and bronchopulmonory dysplasia between the two groups.</p><p><b>CONCLUSIONS</b>nSIMV for premature infants with severe RDS after extubation not only significantly improves lung function and reduces the rate of extubation failure, also results in a lower incidence of gastrointestinal side effects and does not increase the incidence of complications.</p>

Pulmonary Outcomes of Early Extubation in Extremely Premature Infants (Gestational Age: 25-26 Weeks) with Synchronized Nasal Intermittent Positive-Pressure Ventilation

PURPOSE: To investigate the pulmonary outcomes of early extubation (within the first 24 hours of life) with synchronized nasal intermittent positive pressure ventilation (NIPPV) in extremely premature infants born at 25-26 weeks' gestation. METHODS: Medical records of extremely premature infants (gestational age: 25-26 weeks) born and admitted to the Keimyung University Dongsan Medical Center between January 2015 and December 2015 (n=42) were reviewed retrospectively. The early extubation group included infants who were extubated within the first 24 hours of life and was compared with a control group that included infants who remained ventilated beyond the first 24 hours of life. Extubation failure was defined as the need for reintubation within 72 hours after extubation. RESULTS: Of the 35 enrolled infants, 22 (62.9%) were extubated within the first 24 hours of life. No significant differences in perinatal factors were observed between the early extubation and control groups. Between the two groups, the incidence rates of extubation failure (18.2% [4/22] vs. 7.7% [1/13], P=0.39), reintubation (50.0% [11/ 22] vs. 46.2% [6/13], P=0.84), mortality (18.2% [4/22] vs. 15.4% [2/13], P=0.83), and the combined rates of clinical bronchopulmonary dysplasia (BPD) or death (40.9% [9/22] vs. 38.5% [5/13], P=0.89) did not significantly differ. CONCLUSION: Early extubation (within the first 24 hours of life) with synchronized NIPPV is safe and effective in the extremely premature infants born at 25-26 weeks' gestation, and does not indicate increased risks of extubation failure and other morbidities.

Respiratory support with heated humidified high flow nasal cannula in preterm infants / 소아과

The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.

Bispectral index in calves anesthetized with xylazine, midazolam, ketamine, isoflurane and subjected to continuous rate infusion of lidocaine

PURPOSE: To assess the bispectral index (BIS) and recovery in calves anesthetized with xylazine, midazolam, ketamine and isoflurane and subjected to CRI of lidocaine. METHODS: Xilazine was administered followed by ketamine and midazolam, orotracheal intubation and maintenance on isoflurane using mechanical ventilation. Lidocaine (2 mg kg-1 bolus) or saline (0.9%) was administered IV followed by a CRI (100 µg kg-1 minute-1) of lidocaine (L) or saline (C). Were recorded BIS, heart rate (HR), mean arterial pressure (MAP) and rectal temperature (RT) before administration of premedication (TB) and 15 minutes after (TX), before administering lidocaine (T0) and 20, 40, 60 and 80 minutes after the start of the CRI . Time do sternal recumbency (SRE) and standing (ST) and plasma lidocaine concentration also evaluated. RESULTS: In both treatments BIS decreased significantly at all times compared to TB. TX was higher than the subsequent times. HR decreased from baseline at all times and decreased from T40 in L compared to C. SRE was higher in L compared to C. CONCLUSIONS: Bispectral index values were consistent with the degree of hypnosis of the animals. Lidocaine did not potentiate isoflurane anesthesia assessed by BIS in unstimulated calves anesthetized with constant E´Iso. Lidocaine increased the time to sternal recumbency. .

Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story

<p><b>INTRODUCTION</b>Late preterm (LP) neonates (34 to 36 weeks gestation) are often managed like term neonates though current literature has identified them to have greater complications. The primary objective of our study was to evaluate and compare morbidity and resource utilisation in LPs especially in view of paucity of Asian studies in this regard.</p><p><b>MATERIALS AND METHODS</b>A retrospective audit was carried out on 12,459 neonates born in KK Women's and Children's Hospital (KKWCH). The chief outcome measures were hypoglycaemia, hypothermia, respiratory morbidity, feeding problems and neonatal jaundice. Resource utilisation included neonatal intensive care unit (NICU) admission, mechanical ventilation, parenteral nutrition and length of hospitalisation.</p><p><b>RESULTS</b>Of 12,459 deliveries, 1221 (10%) were LP deliveries with a significantly increasing trend of 8.6% to 10% from 2002 to 2008 (P = 0.001). Neonatal morbidity in the form of hypoglycaemia (34 weeks vs 35 to 36 weeks vs term: 26% vs 16% vs 1%); hypothermia (5% vs 1.7% vs 0.2%); feeding difficulties (30% vs 9% vs 1.4%); respiratory distress syndrome (RDS) (4% vs 1% vs 0.1%); transient tachypnea of the newborn (TTNB) (23% vs 8% vs 3%) and neonatal jaundice (NNJ) needing phototherapy (63% vs 24% vs 8%), were significantly different between the 3 groups, with highest incidence in 34-week-old infants. Resource utilisation including intermittent positive pressure ventilation (IPPV) (15% vs 3.5% vs 1%), total parenteral nutrition/intravenous (TPN/IV) (53% vs 17% vs 3%) and length of stay (14 ± 22 days vs 4 ± 4.7 days vs 2.6 ± 3.9 days) was also significantly higher (P <0.001) in LPs.</p><p><b>CONCLUSION</b>LP neonates had significantly higher morbidity and resource utilisation compared to term infants. Among the LP group, 34-week-old infants had greater complications compared to infants born at 35 to 36 weeks.</p>

Tension pneumothorax during tracheoesophageal fistula repair: A case report

Tension pneumothorax (PTx) was diagnosed in a preterm baby during surgery for tracheoesophageal fistula (TEF). The PTx occurred around 90 minutes after skin incision, while the baby was breathing spontaneously with intermittent positive pressure ventilation (PPV) at low pressure. A sudden decrease in oxygen saturation (SpO2), hemodynamic compromise, and decreased breath sounds on the right side suggested a right-sided tension PTx. After prompt radiological confirmation, needle aspiration of air through the surgical site restored the patient's condition immediately. Although the sudden unexpected hypoxemia and circulatory problems may confuse anesthesiologists, prompt diagnosis and proper treatment are required for successful clinical outcomes in tension PTx.

The effects of different ventilator modes on cerebral tissue oxygen saturation in patients with bidirectional superior cavopulmonary connection.

Aims and Objectives: We used near‑infrared spectroscopy to document changes in cerebral tissue oxygen saturation (SctO2) in response to ventilation mode alterations after bidirectional Glenn (BDG; superior cavopulmonary connection) procedure. We also determined whether spontaneous ventilation have a beneficial effect on hemodynamic status, lactate and SctO2 when compared with other ventilation modes. Materials and Methods: 20 consecutive patients undergoing BDG were included. We measured SctO2 during three ventilator modes (intermittent positive‑pressure ventilation [IPPV]; synchronized intermittent mandatory ventilation [SIMV]; and continuous positive airway pressure + pressure support ventilation [CPAP + PSV]). We, also, measured mean airway pressure (AWP), arterial blood gases, lactate and systolic arterial pressures (SAP). Results: There was no change in SctO2 in IPPV and SIMV modes; the SctO2 measured during CPAP + PSV and after extubation increased significantly (60.5 ± 11, 61 ± 10, 65 ± 10, 66 ± 11 respectively) (P < 0.05). The differences in the SAP measured during IPPV and SIMV modes was insignificant; the SAP increased significantly during CPAP + PSV mode and after extubation compared with IPPV and SIMV (109 ± 11, 110 ± 12, 95 ± 17, 99 ± 13 mmHg, respectively) (P < 0.05). Mean AWP did not change during IPPV and SIMV modes, mean AWP decreased significantly during CPAP + PSV mode (14 ± 4, 14 ± 3, 10 ± 1 mmHg, respectively) (P < 0.01). Conclusions: The SctO2 was higher during CPAP + PSV ventilation and after extubation compared to IPPV and SIMV modes of ventilation. The mean AWP was lower during CPAP + PSV ventilation compared to IPPV and SIMV modes of ventilation.

Clinical application of nasal intermittent positive pressure ventilation in initial treatment of neonatal respiratory distress syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical effectiveness and safety of nasal intermittent positive pressure ventilation (NIPPV) in the initial treatment of neonatal respiratory distress syndrome (NRDS) and the initial setting of NIPPV parameters.</p><p><b>METHODS</b>One hundred neonates with NRDS were divided into NIPPV group (n=50) and nasal continuous positive airway pressure (NCPAP) group (n=50). A randomized controlled study was conducted to compare the effectiveness of NIPPV versus NCPAP in the initial treatment of NRDS from the following aspects: reducing CO2 retention, improving oxygenation, reducing second endotracheal intubation and second use of pulmonary surfactant (PS), reducing the duration of invasive respiratory support, reducing the duration of oxygen use, and reducing the incidence of air leak, abdominal distension and ventilator-associated pneumonia.</p><p><b>RESULTS</b>After 1 and 6 hours of noninvasive respiratory support, the NIPPV group was superior to the NCPAP group with respect to the reduction in CO2 retention and improvement in oxygenation (P<0.05); in addition, compared with the NCPAP group, the NIPPV group had significantly lower rates of second endotracheal intubation and second PS use, significantly shorter duration of invasive respiratory support and time of FiO2 >0.21, and significantly lower incidence of apnea and ventilator-associated pneumonia (P<0.05); there were no significant differences in the incidence of air leak and abdominal distention between the two groups.</p><p><b>CONCLUSIONS</b>NIPPV is effective and safe in the initial treatment of NRDS and holds promise for clinical application.</p>

Current application of noninvasive ventilation in preterm infants with respiratory distress syndrome / 中国当代儿科杂志

In order to reduce the serious complications associated with invasive mechanical ventilation, non-invasive ventilation (NIV) has increasingly been chosen as the primary ventilation in preterm infants with respiratory distress syndrome (RDS). In the last 4 decades, nasal continuous positive airway pressure (NCPAP) has been as a main, or even the only mode of NIV in preterm infants with RDS. In the recent decade, improvements in sensors and nasal airway interfaces have resulted in the introduction of a variety of other new types of NIV, such as nasal intermittent positive pressure ventilation (NIPPV), bi-level positive airway pressure (BiPAP). Subsequent studies have shown that some new modes may be more superior to NCPAP in preterm infants with RDS. In order to further understand the application of various NIV modes, we review literatures about all kinds of NIV as a primary mode of ventilation in preterm infants with RDS.

Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: a randomized controlled trial

Neonatal respiratory distress syndrome [RDS] in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation [MV] nowadays researchers in interested minimizing MV. To determine, in very low birth weight [BW] preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation [early NIMV] compared with early nasal continuous positive airway pressure [early NCPAP] obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. In this single-center randomized control trial study, infants [BW 30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. 98 infants were enrolled [44 in the NIMV and 54 in the NCPAP group]. The Preventive power of MV of NIMV usage [95.5%] was not lower than the NCPAP [98.1%] strength [hazard ratio: 0.21 [95% confidence interval: 0.02-2.66]; P: 0.23]. The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP [the median [range] was 24 [18.00-48.00] h versus 48.00 [22.00-120.00] h in NIMV versus NCPAP groups; P < 0.001]. Similarly, the duration of dependency on oxygen was less, for NIMV [the median [range] was 96.00 [41.00-504.00] h versus144.00 [70.00-1130.00] h in NIMV versus NCPAP groups; P: 0.009]. Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group

The effects on Apgar scores and neonatal outcomes of switching from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic vasopressor during spinal anesthesia for cesarean section / 대한마취과학회지

BACKGROUND: Ephedrine, unlike phenylephrine, has a dose-related propensity to depress fetal pH during spinal anesthesia during cesarean section. A low arterial umbilical cord pH has a strong association with neonatal mortality and morbidity. The purpose of this retrospective study was to investigate influences of vasopressor change on Apgar scores and adverse neonatal outcomes in cesarean section. METHODS: In obstetric anesthesia, we changed the prophylactic vasopressor from a combination of phenylephrine and ephedrine to phenylephrine alone in 2000. We evaluated the impact of vasopressor change on Apgar scores (1 and 5 min), incidence of Apgar score < 7 (1 and 5 min), neonatal seizure, continuous positive airway pressure (CPAP), intermittent positive pressure ventilation (IPPV), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), and hypoxic ischemic encephalopathy (HIE) in low-risk elective cesarean sections during a period when the combination of phenylephrine and ephedrine was used (2008-2009, two years) and the period of phenylephrine use alone (2011-2012, two years). RESULTS: There were no differences in Apgar scores (1 and 5 min), the incidence of 5 min Apgar score < 7, neonatal seizure, CPAP, IPPV, IVH, PVL, and HIE between the two time periods. However, the incidence of 1 min Apgar < 7 was decreased during the period of phenylephrine use compared with the period of phenylephrine and ephedrine use (P = 0.002). CONCLUSIONS: Conversion from a combination of phenylephrine and ephedrine to phenylephrine alone as a prophylactic anti-hypotensive drug during spinal anesthesia for cesarean section in low-risk pregnancy may be associated with a significant decrease in the incidence of 1 min Apgar < 7.

Comparison of Effectiveness of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation for the Initial Treatment of Preterm Respiratory Distress Syndrome: A Prospective Pilot Study

PURPOSE: To compare respiratory and clinical outcomes between the currently used strategy of Intubation, Surfactant, Extubation (InSurE) and nasal continuous positive airway pressure (NCPAP) and the alternative strategy of InSurE and nasal intermittent positive pressure ventilation (NIPPV) for the initial treatment of respiratory distress syndrome (RDS) in preterm newborns < or =32 weeks. METHODS: Twenty-six comparable preterm infants with RDS were included in the study; 13 were randomized to NCPAP and 13 to NIPPV. In both groups, the InSurE procedure consisted of intubation, surfactant instillation and 2 h positive pressure ventilation followed by extubation, after which spontaneously breathing newborns were placed on NCPAP or NIPPV. RESULTS: There were no differences in demographic characteristics or cardiorespiratory status among preterm infants enrolled in the study. The reinutation rate was lower among the infants treated with NIPPV than among those on NCPAP (8% vs. 46%, P<0.05) and the rate of aminophylline use between 4 and 7 days of age of was lower in the NIPPV group compared to the NCPAP group (8% vs. 30%, P<0.05). In addition, "InSurE with NIPPV" significantly reduced the overall duration of endotracheal ventilation and shortened the time to first feed compared to "InSurE with NCPAP". CONCLUSION: "InSurE with NIPPV" displayed therapeutic benefits as the initial treatment of preterm RDS when compared with the currently used ventilator strategy, "InSurE with NCPAP" by preventing re-intubation and shortening the duration of endotracheal ventilation.