Pancuronium Prevents Pneumothoraces in Ventilated Premature Babies Who Actively Expire Against Positive Pressure Inflation

Greenough, A; Morley, C J; Wood, Steve; Davis, John A.; Smith, Robert M.

doi:10.1097/00132586-198408000-00070

Cited by 34 publications

(55 citation statements)

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“…The risk of pneumothorax has been found to increase in cases of nonphasic respiration in new borns [11]. This study favors the idea of baby-triggered ventilators as a more physio logical alternative because the artificial si mulation of the rhythmic events of respira tion of a premature baby seems tricky in deed.…”

Section: Discussionmentioning

confidence: 54%

Spectral Analysis of Impedance Respirogram in Newborn Infants

Äärimaa¹,

Välimäki²

1988

Neonatology

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Respiratory rate (RR), transthoracic electric impedance (TEZ) and transcutaneous PO₂ and PCO₂ were monitored during the 5 first postnatal days in 54 neonates on three separate occasions. There was no difference in the overall RR between the term and healthy preterm babies on different days of recordings but RR of the babies with RDS (who were all ventilated) was lower on day 1 (p < 0.01). When the power spectrum of the TEZ respirogram was computed and the spectral density was divided into low-frequency (LF, < 0.20 Hz) and high-frequency (HF, > 0.20 Hz) areas, the LF/HF ratio of healthy preterm babies was greater than that of term babies on day 1 (p < 0.01). The preterm babies with RDS did not differ from the term babies in this respect. The LF/HF ratio was negatively correlated with gestational age and it had a positive correlation to P_tcO₂ (p < 0.05) and P_tcCO₂ (p < 0.01) (R2 = 0.07). The result evidences that the control of respiration changes in relation to maturity and the LF/HF ratio is a quantitative indicator of respiratory variability reflecting this development.

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Section: Discussionmentioning

confidence: 54%

Spectral Analysis of Impedance Respirogram in Newborn Infants

Äärimaa¹,

Välimäki²

1988

Neonatology

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“…By comparison of the oesophageal and ventilator pressure record it was possible to determine the infant's interaction to positive pressure inflation.6 7 One of the aims of our investigation was to study this form of ventilation in a consecutive series of infants to assess its usefulness as a general mode of ventilation. Although most of our patients suffered from respiratory distress syndrome other diagnoses were included and we found patient triggered ventilation to be useful in most (13 of 14)-that is, oxygenation improved.…”

Section: Methodsmentioning

confidence: 99%

Neonatal patient triggered ventilation.

Greenough

Pool

1988

Archives of Disease in Childhood

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“…Most of the infant-ventilator asynchrony was associated with expiratory asynchrony, in which the ventilator continued to deliver assist despite the fact that diaphragm activation was decreasing. According to the literature, there are severe consequences of expiratory asynchrony, the most important being that active exhalation against positive-pressure inflation develops pneumothoraces (37), barotrauma (3,38), and cerebral blood flow fluctuations, which can be associated with intraventricular hemorrhage (39). In extreme cases of 753 expiratory asynchrony, use of sedation or muscle paralysis is sometimes necessary (38,40,41).…”

mentioning

confidence: 99%

“…According to the literature, there are severe consequences of expiratory asynchrony, the most important being that active exhalation against positive-pressure inflation develops pneumothoraces (37), barotrauma (3,38), and cerebral blood flow fluctuations, which can be associated with intraventricular hemorrhage (39). In extreme cases of 753 expiratory asynchrony, use of sedation or muscle paralysis is sometimes necessary (38,40,41). In the adult literature, it is clear that poor off-cycling of mechanical ventilation results in an increased work of breathing (42) and patient discomfort (43).…”

mentioning

confidence: 99%

Prolonged Neural Expiratory Time Induced by Mechanical Ventilation in Infants

et al. 2004

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Mechanical ventilation may interfere with the spontaneous breathing pattern in infants because they have strong reflexes that play a large role in the control of breathing. This study aimed to answer the following questions: does a ventilator-assisted breath 1) reduce neural inspiratory time, 2) reduce the amplitude of the diaphragm electrical activity, and 3) prolong neural expiration, within the delivered breath? In 14 infants recovering from acute respiratory failure (mean age and weight were 2.3 Ϯ 1.3 mo and 3.95 Ϯ 0.82 kg, respectively), we measured 1) the electrical activity of the diaphragm with a multiple-array esophageal electrode, and 2) airway opening pressure, while patients breathed on synchronized intermittent mandatory ventilation (mean rate, 11.2 Ϯ 6.5 breaths/min). We compared neural inspiratory and expiratory times for the mandatory breaths and for the spontaneous breaths immediately preceding and following the mandatory breath. Although neural inspiratory time was not different between mandatory and spontaneous breaths, neural expiratory time was significantly increased (p Ͻ 0.001) for the mandatory breaths (953 Ϯ 449 ms) compared with the premandatory and postmandatory spontaneous breaths (607 Ϯ 268 ms and 560 Ϯ 227 ms, respectively). Delivery of the mandatory breath resulted in a reduction in neural respiratory frequency by 28.6 Ϯ 6.4% from the spontaneous premandatory frequency. The magnitude of inspiratory electrical activity of the diaphragm was similar for all three breath conditions. For the mandatory breaths, ventilatory assist persisted for 507 Ϯ 169 ms after the end of neural inspiratory time. Infant-ventilator asynchrony (both inspiratory and expiratory asynchrony) was present in every mandatory breath and constituted 53.4 Ϯ 26.2% of the total breath duration. Newborn infants have strong reflexes that play a large role in the control of breathing (1). The work of Hering and Breuer in 1868 demonstrated in newborn animals that expansion of the lung reflexly inhibits inspiration-the HB inspiratoryinhibiting reflex-and promotes expiration-the HB expiratory-promoting reflex (2). With respect to mechanical ventilation in infants, it is reasonable to expect that delivery of ventilatory assistance should reflexly reduce neural Ti and neural inspiratory activity within the breath delivered. With respect to the HB expiratory-promoting reflex, one would expect an increase in neural Te during the assisted breath, compared with a spontaneous unassisted breath. The expiratory-promoting reflex has been clinically observed in mechanically ventilated infants, but was described with indirect estimates of neural timing (such as airway or esophageal pressure or flow) to gauge its effects (3-5). In addition to the fact that no quantitative evaluation of the reflex was made, the recent work of Parthasarathy et al. (6) has demonstrated that indirect estimates of respiratory timing are in poor agreement with more direct measurements of neural activity.Much of the available literature on reflex control of ...

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Pancuronium Prevents Pneumothoraces in Ventilated Premature Babies Who Actively Expire Against Positive Pressure Inflation

Cited by 34 publications

References 0 publications

Spectral Analysis of Impedance Respirogram in Newborn Infants

Spectral Analysis of Impedance Respirogram in Newborn Infants

Neonatal patient triggered ventilation.

Prolonged Neural Expiratory Time Induced by Mechanical Ventilation in Infants

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