Decrease of Functional Residual Capacity and Ventilation Homogeneity after Neuromuscular Blockade in Anesthetized Young Infants and Preschool Children

Ungern‐Sternberg, Britta S. von; Hammer, Jürg; Schibler, Andreas; Frei, Franz J.; Erb, Thomas O.

doi:10.1097/00000542-200610000-00010

Cited by 75 publications

(86 citation statements)

References 18 publications

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“…Thoracic and abdominal surgery infants had similar FRCs at extubation (19.04¡6.0 and 18.88¡ 4.0 mL?kg -1 , respectively). Although all infants were successfully extubated and the neuromuscular blockade was removed, the FRC values were slightly lower than that reported by VON UNGERN-STERNBERG et al [8] in intubated infants prior to anaesthetic procedures (21.3¡4.7 mL?kg -1 ). However, the infants in the present study were younger and lighter than those in the study by VON UNGERN-STERNBERG et al [8], and the present FRC values are consistent with those for ventilated pre-term infants [21,22] and nonventilated full-term control infants (18.4 mL?kg -1 ) [23].…”

Section: Neonatal Critical Care H Proquitté Et Alcontrasting

confidence: 57%

“…While this problem can be easily overcome in ventilated older patients by using cuffed ETs [8], uncuffed ETs are advised in neonates both to protect airways and to avoid subglottic stenosis [26]. In our study, we could exclude a substantial effect of ET leakage on FRC measurements.…”

Section: Neonatal Critical Care H Proquitté Et Almentioning

confidence: 89%

“…Most MBWO measurements in ventilated newborns are performed using custom-made equipment and nitrogen [27], helium [28] or sulfur hexafluoride (SF6) [7] as tracer gases. The commercial system for MBWO in ventilated patients [9] used by VON UNGERN-STERNBERG et al [8] is based on ultrasound spirometry with SF6 as the tracer gas. That equipment has a high VD,app and a bulky and heavy measuring head, and its use was shown to be feasible predominantly in ventilated older infants or preschool children aged from 13 months to 7 yrs [29][30][31].…”

Section: Neonatal Critical Care H Proquitté Et Almentioning

confidence: 99%

“…Meanwhile, commercial equipment is available to assess lung aeration by measuring functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices [5][6][7]. This noninvasive method is based on the multiple breath washout (MBWO) measurement technique using a tracer gas [8]. However, the equipment used for simultaneously measuring airflow and molar mass of the breathing gas is generally bulky and cumbersome for routine applications in intubated newborns or premature infants, and requires significant floor space [9].…”

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confidence: 99%

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The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Proquitté¹,

Freiberger²,

Yılmaz³

et al. 2009

Eur Respir J

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In newborn infants, thoraco-abdominal surgery is a serious intervention with respect to gas exchange and lung mechanics. This prospective clinical study compared surgery-induced changes in functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices with changes in conventional monitoring parameters.Of 29 ventilated newborns (mean weight 2,770¡864 g at surgery), 13, nine and seven underwent thoracic, abdominal or congenital diaphragmatic hernia (CDH) surgery, respectively. The multiple breath washout (MBWO) technique using heptafluoropropane as tracer gas (Babylog1 8000; Dräger, Lübeck, Germany) was performed ,6 h before surgery, 22-24 h after surgery and ,6 h before extubation. Gas exchange, respiratory mechanics, FRC and VI index data were recorded.Thoraco-abdominal surgery resulted in changes to FRC and VI indices in a procedure-specific manner; however, these changes were not reflected in conventional mechanical or ventilatory monitoring parameters. FRC decreased in non-CDH infants, while FRC increased and VI indices decreased in CDH infants. Despite improvements, the differences in FRC and VI between CDH and non-CDH infants indicated persistent impaired lung function in CHD infants.MBWO can be advantageously used to measure the effect of surgery on the lung. While FRC and VI indices changed following surgery, conventional monitoring parameters did not.KEYWORDS: Congenital diaphragmatic hernia, lung volume, mechanical ventilation, multiple breath washout, newborn infant, thoraco-abdominal surgery S urvival in newborn infants following corrective surgery for serious cardiac [1,2] or abdominal wall defects [3] or for congenital diaphragmatic hernia (CDH) [4] has improved over the last decade. Nevertheless, opening the thoracic cavity and/or abdominal wall remains a significant intervention with respect to temporary alterations in gas exchange and lung volume.In addition to ventilator monitoring, blood gas analyses and repeated radiographs are usually performed in ventilated infants to monitor clinical development. Meanwhile, commercial equipment is available to assess lung aeration by measuring functional residual capacity (FRC) and ventilation inhomogeneity (VI) indices [5][6][7]. This noninvasive method is based on the multiple breath washout (MBWO) measurement technique using a tracer gas [8]. However, the equipment used for simultaneously measuring airflow and molar mass of the breathing gas is generally bulky and cumbersome for routine applications in intubated newborns or premature infants, and requires significant floor space [9]. We have recently validated a prototype of an extended neonatal ventilator for MBWO analysis in small ventilated piglets [10]. This apparatus uses a miniaturised lightweight gas sensor and heptafluoropropane (HFP) as the tracer gas.We hypothesised that this technique can be advantageously used in a clinical setting to measure the effect of surgery on the lung. The aim of the present prospective clinical study was the use of the HPF-MBWO technique to i...

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Section: Neonatal Critical Care H Proquitté Et Alcontrasting

confidence: 57%

Section: Neonatal Critical Care H Proquitté Et Almentioning

confidence: 89%

Section: Neonatal Critical Care H Proquitté Et Almentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The effect of surgery on lung volume and conventional monitoring parameters in ventilated newborn infants

Proquitté¹,

Freiberger²,

Yılmaz³

et al. 2009

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…9 Prune-Belly sendromlu hastalarda, var olan anatomik güçlüklerin yanı sıra anestezi sırasında ve sonrasında da fonksiyonel rezidüel kapasite, total akciğer kapasitesinin azalmasının, ek olarak, pnömoperitonyum ve trendelenburg pozisyonu gibi etkenlerin atelektazi riskini arttırdığı bildirilmiştir. 10 Sunulan ilk olguda, laparoskopik cerrahi olması açısından postoperatif solunumsal komplikasyon görülme olasılığının artabileceği düşünülmüş, aynı zamanda bu dö-nemde rezidüel nöromusküler bloker etkisini ortadan kaldırmak, akciğer volümlerinin daha az etkilenmesini sağlamak amacıyla nöromusküler bloker kullanılmamıştır. .…”

Section: Discussionunclassified