Beatmung von Neugeborenen und Säuglingen

Berger, Thomas M.; Stocker, Martin

doi:10.1007/s00101-004-0708-y

Cited by 21 publications

(1 citation statement)

References 36 publications

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“…This can be achieved by accepting pCO2 between 45 Á/ 55 mmHg, arterial pH of 7.25 Á/7.35 and oxygen saturations between 88 and 93%. Improvements in oxygenation and lung compliance may also be achieved by increasing the positive end expiratory pressure (PEEP) to levels that maintain optimal recruitment and minimize atelectasis-induced lung injury [52]. In addition, by reducing LV after-load, increased PEEP leads to improvements in myocardial performance and cardiac output [53].…”

Section: Specific Guidelines For Intervention 1 Focused Intensive Carementioning

confidence: 99%

Enhanced intensive care for the neonatal ductus arteriosus

Teixeira

McNamara

2006

Acta Paediatrica

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Failure of ductal closure is common in extremely low birth weight infants with significant postnatal morbidities from both pulmonary overcirculation (i.e. chronic lung disease) and/or systemic hypoperfusion (i.e. necrotizing enterocolitis). Early clinical signs of a hemodymanically significant ductus may be non-specific (i.e. hypotension, increasing ventilator requirements, metabolic acidosis) necessitating early screening by echocardiography. Cyclooxygenase inhibitors remain the first-line treatment option. Indomethacin remains the most commonly used agent, despite comparable efficacy and reduced risk of adverse events with ibuprofen. Surgical intervention is recommended after failure of medical therapy, contraindications to medical treatment or fulminating duct-related cardiorespiratory deterioration. Wherever possible, surgical intervention in ELBW infants should be avoided in the first week of life due to the potential risks of ischemia-reperfusion cerebral hemorrhage. The postoperative course is often complicated by left ventricular failure, pulmonary edema, and/or hemodynamic instability requiring close monitoring and physiologically relevant therapeutic interventions.

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Section: Specific Guidelines For Intervention 1 Focused Intensive Carementioning

confidence: 99%

Enhanced intensive care for the neonatal ductus arteriosus

Teixeira

McNamara

2006

Acta Paediatrica

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Premature Infants Show Consistently Good Lung Compliance During Conventional Mechanical Ventilation

Reiss,

Lauth,

Wald

2024

Pediatric Pulmonology

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IntroductionMany extremely small preterm infants need to be intubated and mechanically ventilated during their intensive care stay. Animal studies indicate that lung compliance can deteriorate rapidly under conventional ventilation. This study investigated whether this presumed deterioration in compliance actually occurs in extremely small preterm infants.MethodsData from 56 conventionally ventilated preterm infants born from 2016 to 2022 at 25.22 weeks' gestation (±1.47) and 678.71 g (±138.14) birth weight were retrospectively analysed. This study investigated how dynamic compliance changed over the course of ventilation.ResultsThe infants were conventionally ventilated from 7.25 days of life (±5.59) for 2.68 days (±2.35). Compliance at the beginning was 0.37 mL/cmH2O/kg (±0.17), after 1 h 0.38 mL/cmH2O/kg (±0.16), after 3 h 0.40 mL/cmH2O/kg (±0.20), after 6 h 0.44 mL/cmH2O/kg (±0.23), after 24 h 0.46 mL/cmH2O/kg (±0.17) and after 48 h 0.43 mL/cmH2O/kg (±0.13). The increase in compliance compared to baseline was statistically significant after 12 (p = 0.016) and 24 h (p = 0.042). Ventilation was performed with a PEEP of 7.51 cmH2O (±1.16) and a peak pressure of 20.64 cmH2O (±2.73). All received surfactant after birth and 21 (37.5%) also at the start of conventional ventilation.ConclusionDuring conventional ventilation in premature infants after administration of surfactant and with basically recruited lungs, no deterioration in compliance was observed either in the short or long term. The PEEP of almost 7.5 cmH2O used may have contributed to the fact that the deterioration described in the animal model did not occur in the preterm infants.

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