Determination of Lung Volume and Hemodynamic Changes During High-Frequency Ventilation Recruitment in Preterm Neonates With Respiratory Distress Syndrome

Tana, Milena; Polglase, Graeme R.; Cota, Francesco; Tirone, Chiara; Aurilia, Claudia; Lio, Alessandra; Ricci, Cinzia; Romagnoli, Costantino; Vento, Giovanni

doi:10.1097/ccm.0000000000000967

Cited by 28 publications

(24 citation statements)

References 22 publications

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“…No specific mode of ventilation has consistently demonstrated superiority; however, irrespective of the mode, avoidance of under-recruitment or hyperinflation is important. When lung volume is excessive, airway pressure exerts a compressive force against the capillaries within respiratory units and is associated with increasing PVR (59), reduced PBF (60), reduced LV end-diastolic volume, (61) LV stroke volume (61), and reduced systemic perfusion (62).…”

Section: Approach To Respiratory Supportmentioning

confidence: 99%

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Giesinger

Odame

et al. 2017

Pediatr Res

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It is increasingly recognized that the abnormal physiologic consequences of pulmonary hypertension (PH) may contribute to poor cardiopulmonary health in premature babies. Conflicting literature has led to clinical uncertainty, pathological misinterpretation, and variability in treatment approaches among practitioners. There are several disorders with overlapping and interrelated presentations, and other disorders with a similar clinical phenotype but diverse pathophysiological contributors. In this review, we provide a diagnostic approach for acute hypoxemic respiratory failure in the preterm neonate, outline the pathophysiological conditions that may present as acute PH, and discuss the implications of high pulmonary vascular resistance (PVR) on the cardiovascular system. Although PVR and respiratory management are highly interrelated, there may be a population of preterm neonates in whom inhaled nitric oxide may improve illness severity and may relate to outcomes. A management approach based on physiology that considers common clinical conundrums is provided. A more comprehensive understanding of the physiology may help in informed decision-making in clinical situations where conclusive scientific evidence is lacking. Regardless, high-quality research is required, and appropriate definition of the target population is paramount. A thoughtful approach to cardiovascular therapy may also provide an avenue to improve neurodevelopmental outcomes while awaiting more clear answers.

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Section: Approach To Respiratory Supportmentioning

confidence: 99%

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Giesinger

Odame

et al. 2017

Pediatr Res

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“…Additionally, fluid overload in an oliguric patient leads to pulmonary edema resulting in increased ventilator settings to offset the effect of the stiffening lungs (21,36). The resultant increase in the mean airway pressure leads to decreased venous return to the heart and exacerbates the poor renal perfusion (58). …”

Section: Clinical Consequences Of Aki In Neonatesmentioning

confidence: 99%

Non-dialytic management of acute kidney injury in newborns

et al. 2016

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Treating acute kidney injury (AKI) in newborns is often challenging due to the functional immaturity of the neonatal kidney. Because of this physiological limitation, renal replacement therapy (RRT) in this particular patient population is difficult to execute and may lead to unwanted complications. Although fluid overload and electrolyte abnormalities, as seen in neonatal AKI, are indications for RRT initiation, there is limited evidence that RRT initiated in the first year of life improves long-term outcome. The underlying cause of AKI in a newborn patient should determine the treatment strategies to restore appropriate renal function. However, our understanding of this common clinical condition remains limited, as no standardized, evidence-based definition of neonatal AKI currently exists. Non-dialytic management of AKI in these patients may restore appropriate renal function to these patients without exposure to complications often encountered with RRT.

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“…The majority of neonatal studies are from old series when open lung recruitment and protective strategies were not widely used. HFOV provides the potential to maintain adequate gas exchange without imposing the large pressure swings and tidal volume changes associated with induced lung injury [15,22,23].…”

Section: Discussionmentioning

confidence: 99%

An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation

et al. 2019

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Background To achieve gas exchange goals and mitigate lung injury, infants who fail with conventional ventilation (CV) are generally switched to high-frequency oscillatory ventilation (HFOV). Although preferred in many neonatal intensive care units (NICUs), research on this type of rescue HFOV has not been reported recently. Methods An online registry database for a multicenter, prospective study was set to evaluate factors affecting the response of newborn infants to rescue HFOV treatment. The study population consisted of 372 infants with CV failure after at least 4 hours of treatment in 23 participating NICUs. Patients were grouped according to their final outcome as survived (Group S) or as died or received extracorporeal membrane oxygenation (ECMO) (Group D/E). Patients’ demographic characteristics and underlying diseases in addition to their ventilator settings, arterial blood gas (ABG) analysis results at 0, 1, 4, and 24 hours, type of device, ventilation duration, and complications were compared between groups. Results HFOV as rescue treatment was successful in 58.1% of patients. Demographic and treatment parameters were not different between groups, except that infants in Group D/E had lower birthweight (BW) (1655 ± 1091 vs. 1858 ± 1027 g, p = 0.006), a higher initial FiO 2 setting (83% vs. 72%, p < 0.001), and a higher rate of nitric oxide exposure (21.8% vs. 11.1%, p = 0.004) in comparison to infants who survived (Group S). The initial cut-offs for a successful response on ABG were defined as pH >7.065 (OR: 19.74, 95% CI 4.83–80.6, p < 0.001), HCO 3 >16.35 mmol/L (OR: 1.06, 95% CI 1.01–1.1, p = 0.006), and lactate level <3.75 mmol/L (OR: 1.09%95 CI 1.01–1.16, p = 0.006). Rescue HFOV duration was associated with retinopathy of prematurity ( p = 0.005) and moderate or severe chronic lung disease ( p < 0.001), but not with patent ductus arteriosus or intraventricular hemorrhage, in survivors ( p > 0.05). Conclusion Rescue HFOV as defined for this population was successful in more than half of the patients with CV failure. Although the response was not associated with gestational age, underlying disease, device used, or initial MV settings, it seemed to be more effective in patients with higher BW and those not requiring nitric oxide. Initial pH, HCO 3 , and lactate levels on ABG may be used as predictors of a response to rescue HFOV.

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Determination of Lung Volume and Hemodynamic Changes During High-Frequency Ventilation Recruitment in Preterm Neonates With Respiratory Distress Syndrome

Cited by 28 publications

References 22 publications

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Controversies in the identification and management of acute pulmonary hypertension in preterm neonates

Non-dialytic management of acute kidney injury in newborns

An observational, prospective, multicenter study on rescue high-frequency oscillatory ventilation in neonates failing with conventional ventilation

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