Cell Count Analysis from Nonbronchoscopic Bronchoalveolar Lavage in Preterm Infants

Dell’Orto, V.; Bourgeois-Nicolaos, Nadège; Rouard, Caroline; Romain, Olivier; Shankar-Aguilera, Shivani; Doucet‐Populaire, Florence; Luca, Danièle De

doi:10.1016/j.jpeds.2018.04.074

Cited by 41 publications

(52 citation statements)

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“…Control neonates also underwent BAL once, when suctioning was clinically indicated for airway cleansing, as these samples are used for microbiological surveillance of intubated patients, according to our internal policy. BAL was performed according to a standardized procedure described elsewhere . In detail, 1 mL/kg 0.9% NaCl (37°C) was injected through a Y‐piece connected to the endotracheal tube to keep the patients ventilated during the lavage.…”

Section: Methodsmentioning

confidence: 99%

Short‐ and long‐term respiratory outcomes in neonates with ventilator‐associated pneumonia

Dell’Orto

Raschetti

Centorrino

et al. 2019

Pediatric Pulmonology

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Background and Objective Ventilator‐associated pneumonia (VAP) is a common nosocomial infection in critical care settings and might have important long‐term consequences in neonates. Our aim is to clarify the short‐ and long‐term respiratory outcomes of neonates affected by VAP. Methods Prospective, population‐based, cohort study with 12 months follow‐up based on clinical examinations and diary‐based respiratory morbidity score, conducted in an academic tertiary referral neonatal unit with dedicated follow‐up program. Results A total of 199 inborn neonates consecutively ventilated for at least 48 hours were eligible for the study. One hundred fifty‐one were finally enrolled and classified as “exposed” or “unexposed” to VAP, if they fulfilled (or not) VAP criteria once during their stay. Bronchopulmonary dysplasia (BPD) incidence was significantly higher in exposed (75%) than in unexposed babies (26.8%; relative risk [RR]: 2.8 [1.9‐4.0]; AdjRR: 3.5 [1.002‐12.7]; P = .049; number needed to harm = 2.07), although the composite BPD/mortality did not differ. Exposed patients showed longer intensive care unit stay (87 [43‐116] vs 14 [8‐52] days; St.β = 0.24; P < .0001) and duration of ventilation (15 [10‐25] vs 5 [4‐8] days; St.β = 0.29; P < .0001) than unexposed neonates. Exposed patients also showed less ventilator‐free days (11 [5‐17.7] vs 22 [14‐24] days; St.β = −0.15; P = .05) compared to unexposed. Respiratory infections, use of drugs, rehospitalization for respiratory reasons, home oxygen therapy, their composite outcome, and diary‐based clinical respiratory morbidity score were similar between the cohorts. Conclusion Neonatal VAP seems associated to higher incidence of BPD, longer ventilation, and intensive care stay but it does not affect long‐term respiratory morbidity.

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Section: Methodsmentioning

confidence: 99%

Short‐ and long‐term respiratory outcomes in neonates with ventilator‐associated pneumonia

Dell’Orto

Raschetti

Centorrino

et al. 2019

Pediatric Pulmonology

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“…As per our in vivo study, this was a physiological, observational one, not intended to change anything in the clinical care. Therefore, we could not do any measurement with nasal prongs, because the use of nasal mask is the current standard of care in our NICU, given its superiority in terms of patients’ comfort and clinical usefulness …”

Section: Discussionmentioning

confidence: 99%

“…The ventilator was checked and tested according to the manufacture's recommendations, before the experiments. The mannequin mouth was closed to avoid leaks and to simulate clinical setting as much as possible, as we usually take care to reduce leaks according to our ventilation NICU protocol . Connections between mannequins, sensors, and lung model have been sealed, as previously described .…”

Section: Methodsmentioning

confidence: 99%

“…We measured pharyngeal pressure (Pphar) in a series of consecutive neonates undergoing nasal mask‐delivered NHFOV under conditions similar to those modeled in our bench study, that is, with the same devices and ventilatory parameters, as well as partial mouth closure achieved by pacifiers or gentle use of chinstraps (Fisher & Paykel Healthcare). These represent the common clinical conditions to provide NHFOV according to our NICU clinical protocol . Pphar was also measured in neonates undergoing other forms of noninvasive respiratory support, such as biphasic positive airway pressure (BiPAP) or noninvasive neurally adjusted ventilator assist (NIV‐NAVA) with the same nasal masks.…”

Section: Methodsmentioning

confidence: 99%

“…We aimed to clarify if leaks occurring in clinical practice (defined as [(Paw − Pphar)/Paw] (in %)) are different comparing nasal mask‐delivered NHFOV and other forms of noninvasive respiratory support. The choice and management of the respiratory support technique was done by the attending physician, based on our NICU clinical protocol, thus no changes in routine clinical care were provided.…”

Section: Methodsmentioning

confidence: 99%

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Mechanics of nasal mask‐delivered HFOV in neonates: A physiologic study

Centorrino

Dell’Orto

Gitto

et al. 2019

Pediatric Pulmonology

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Objectives To clarify if nasal mask influences noninvasive high‐frequency oscillatory ventilation (NHFOV) mechanics to optimize the clinical use of nasal mask‐delivered NHFOV. Working Hypothesis Nasal mask may affect the mechanical efficacy of NHFOV. Methodology We designed a physiologic study composed of an in vitro phase aiming to investigate pressure transmission and volume delivery in a bench model of nasal mask‐delivered NHFOV. In a second phase, we measured the leaks in vivo in a series of neonates receiving nasal mask‐delivered NHFOV or other forms of noninvasive respiratory support with same nasal masks. Results In vitro pressure transmission is lower with nasal mask (pressure at the lung [Plung]: 2 [0.8]), than with the endotracheal tube (Plung 9.5 [1.5] cmH2O; P = 0.007). Same applies for volume delivery (Vol: 0.6 [0.2] vs 1.8 [0.5] mL; P = 0.0001). Increasing ventilatory boundaries slowly affects pressure and volume delivery. Ventilating the model with maximal parameters (∆P = 55 cmH2O; frequency = 8 Hz) we obtained a Vol 1.5 (0.2) mL. The nasal mask provides lower volume delivery and ventilation, compared with nasal prongs studied in previously published studies. Changing frequency allows a better performance than changing ∆P. In vivo leaks are approximately 30% and are similar during NHFOV or other forms of nasal mask‐delivered noninvasive ventilation. Conclusions Nasal mask‐delivered NHFOV is feasible, but it may require more aggressive ventilatory parameters to increase volume delivery and ventilation. The use of the nasal mask is associated with some leaks, but this is independent from the type of noninvasive respiratory support applied.

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Effectiveness of Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation vs Noninvasive High-Frequency Oscillatory Ventilation as Support After Extubation of Neonates Born Extremely Preterm or With More Severe Respiratory Failure

Zhu

Shi

et al. 2023

JAMA Netw Open

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ImportanceThe NASONE (Nasal Oscillation Post-Extubation) trial showed that noninvasive high-frequency oscillatory ventilation (NHFOV) slightly reduces the duration of invasive mechanical ventilation (IMV) in preterm infants, whereas NHFOV and noninvasive intermittent positive pressure ventilation (NIPPV) result in fewer reintubations than nasal continuous positive airway pressure (NCPAP). It is unknown whether NHFOV is similarly effective in extremely preterm neonates or in those with more severe respiratory failure (based on the duration of previous ventilation and CO2 levels).ObjectiveTo clarify whether NHFOV is better than NIPPV and NCPAP in reducing the duration of IMV in extremely preterm neonates or those with severe respiratory failure.Design, Setting, and ParticipantsThis study is a predefined secondary analyses of a multicenter randomized clinical trial that was performed at tertiary academic neonatal intensive care units (NICUs) in China. Participants included neonates enrolled in the NASONE trial between December 2017 and May 2021 and belonging to 3 predefined subgroups: (1) born at less than or equal to 28 weeks’ (plus 6 days) gestation, (2) invasively ventilated for more than 1 week from birth, and (3) with CO2 greater than 50 mm Hg before or in the 24 hours after extubation. Data analysis was performed in August 2022.InterventionNCPAP, NIPPV, or NHFOV since the first extubation and until NICU discharge, with airway pressure higher in NHFOV than in NIPPV and than in NCPAP.Main Outcomes and MeasuresThe co–primary outcomes were total duration of IMV during the NICU stay, need for reintubation, and ventilator-free days calculated as per the original trial protocol. Outcomes were analyzed on an intention-to-treat basis as for the whole trial, and subgroup analyses followed the original statistical plan.ResultsAmong 1137 preterm infants, 455 (279 boys [61.3%]) were born at 28 weeks’ gestation or less, 375 (218 boys [58.1%]) underwent IMV for more than 1 week from birth, and 307 (183 boys [59.6%]) had CO2 greater than 50 mm Hg before or in the 24 hours after extubation. Both NIPPV and NHFOV were associated with significantly fewer reintubations (risk difference range, −28% [95% CI, −39% to −17%] to −15% [95% CI, −25% to −4%]; number needed to treat, 3-7 infants) and early reintubations (risk difference range, −24% [95% CI, −35% to −14%] to −20% [95% CI, −30% to −10%]) than NCPAP, and these reintubations were less frequently due to refractory hypoxemia. IMV was shorter in the NIPPV and NHFOV groups (mean difference range, −5.0 days [95% CI, −6.8 to −3.1 days] to −2.3 days [95% CI, −4.1 to −0.4 days]) than in the NCPAP group. Co–primary outcomes were not different between NIPPV and NHFOV; there was no significant interaction effect. Infants in the NHFOV group showed significantly less moderate-to-severe bronchopulmonary dysplasia than infants in the NCPAP group (range, −12% to −10%; number needed to treat, 8-9 infants) and better postextubation gas exchange in all subgroups. The 3 interventions were provided at different mean airway pressure and were equally safe.Conclusions and RelevanceThe subgroup analyses of extremely preterm or more ill infants confirm the results obtained in the whole population: NIPPV and NHFOV appeared equally effective in reducing duration of IMV compared with NCPAP.Trial RegistrationClinicalTrials.gov Identifier: NCT03181958

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Cell Count Analysis from Nonbronchoscopic Bronchoalveolar Lavage in Preterm Infants

Cited by 41 publications

References 43 publications

Short‐ and long‐term respiratory outcomes in neonates with ventilator‐associated pneumonia

Short‐ and long‐term respiratory outcomes in neonates with ventilator‐associated pneumonia

Mechanics of nasal mask‐delivered HFOV in neonates: A physiologic study

Effectiveness of Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation vs Noninvasive High-Frequency Oscillatory Ventilation as Support After Extubation of Neonates Born Extremely Preterm or With More Severe Respiratory Failure

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