Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants

Woodgate, Paul G; Davies, Mark

doi:10.1002/14651858.cd002061

Cited by 117 publications

(84 citation statements)

References 25 publications

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“…Estudos demonstram que a hipercapnia permissiva é protetora em termos de lesão pulmonar e de lesão hipóxico-isquêmica cerebral [50][51][52] 56 . Apesar de mais estudos serem necessários, a tendência atual é aceitar uma PaCO 2 moderadamente alta, entre 45-65 mmHg e pH > 7,20.…”

Section: Assistência Ventilatória Invasivaunclassified

Strategies to minimize lung injury in extremely low birth weight infants

Suguihara¹,

Lessa²

2005

J Pediatr (Rio J)

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Como citar este artigo: Suguihara C, Lessa AC. Como minimizar a lesão pulmonar no prematuro extremo: propostas. J Pediatr (Rio J). 2005;81(1 Supl):S69-S78. AbstractObjective: To review the main causes of new bronchopulmonary dysplasia and the strategies utilized to decrease its incidence in extremely low birth weight infants. Sources of data:For this review a MEDLINE search from 1966 to October 2004, the Cochrane Database, abstracts from the Society for Pediatric Research and recent meetings on the topic were used. Summary of the findings:The survival of extremely low birth weight infants has increased significantly due to improvement in both scientific knowledge and technology. This improvement in survival has therefore resulted in an increased incidence of bronchopulmonary dysplasia. The characteristics of bronchopulmonary dysplasia in extremely low birth weight infants, the so called new bronchopulmonary dysplasia are quite different from the classic bronchopulmonary dysplasia described by Northway. This new bronchopulmonary dysplasia has a multifactorial etiology, which includes volutrauma, atelectrauma, oxygen toxicity and lung inflammation. Therapy such as prenatal corticosteroids, exogenous surfactant, nasal continuous positive airway pressure, new mechanical ventilation modalities and gentle ventilation have been used in attempts to decrease lung injury severity. Conclusions:In order to prevent lung injury in extremely low birth weight infants, it is necessary to minimize several factors that induce bronchopulmonary dysplasia and to utilize less aggressive therapeutic strategies. In addition to the current therapy used to decrease lung injury, knowledge of these causative factors may create new therapies that may be fundamental in improving the clinical outcomes of premature infants.J Pediatr (Rio J). 2005;81(1 Supl):S69-S78: Extremely low birth weight infant, bronchopulmonary dysplasia, mechanical ventilation. ResumoObjetivo: Apresentar uma revisão das principais causas da nova displasia broncopulmonar e as estratégias utilizadas para diminuir sua incidência nos prematuros extremos. Fontes dos dados:Para essa revisão, pesquisas foram feitas na MEDLINE (1996 a outubro de 2004), no Cochrane Database, em resumos da Society for Pediatric Research e recentes conferências sobre o tema. Síntese dos dados:A tecnologia e os novos conhecimentos científicos têm aumentado significantemente a sobrevida de prematuros extremos. Esse aumento da sobrevida resultou em aumento da incidência de displasia broncopulmonar. Atualmente, a displasia broncopulmonar é mais freqüentemente observada em recém-nascidos < 1.200 g. As características da displasia broncopulmonar nesses prematuros extremos, atualmente chamada de nova displasia broncopulmonar, são bastante diferentes da clássica descrita por Northway. A nova displasia broncopulmonar tem etiologia multifatorial, como volutrauma, atelectrauma, toxicidade ao oxigênio e reação inflamatória. Terapias como corticosteróide pré-natal, surfactante exógeno, pressão aérea positiva co...

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Section: Assistência Ventilatória Invasivaunclassified

Strategies to minimize lung injury in extremely low birth weight infants

Suguihara¹,

Lessa²

2005

J Pediatr (Rio J)

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“…Weeks (gestational age); g (grams birth weight); CPR (cardiopulmonary resucitation); nCPAP (nasal continuous positive airways pressure) Do to these evidences, since 2003 we have also the "Algorithm I" (figure 5) for the extreme preterm less than 27 weeks and 750 grams, which provides for elective intubation and surfactant administered in delivery room at an early stage lung (at birth 15 minutes in delivery room or after a mayor stabilization at the first half hour of life in NICU). At the same time, the "Algorithm II" protocol includes the criteria for failure of nCPAP, or NIV if it was indicated, this is an emergency situation in which we must proceed fasting to his immediate intubation and selective surfactant administration, if there are diagnostic criterions for RDS, carried on an invasive ventilation protective synchronized support (initially assisted or controlled -A/C-, high frequency ventilation -HFV-if it's need a rescue technique, and later guaranteed volume -GV-and sometimes support pressure ventilation -SPV-too), while we maintained a strategy of "permissive hypercapnia" and a minimum "functional oxygenic ranges" through continuous monitoring of end-tidal CO 2 (ETCO 2 ) and skin crosswise oxygen saturation (SatO 2 ), respectively (Woodgate & Davies, 2001). Many currently studies are researching others preventives respiratory postnatal measures: the possibility of administering the surfactant aerosol (Down & Sinha, 2008); new synthetic surfactants; novel protective strategies for invasive ventilation (Morley et al, 2008;Stevens et al, 2007); the more safest range of oxygen saturation; the prophylactic use of inhaled nitric oxide (iNO), (Barrington et al, 2007); an appropriate pattern of postnatal corticosteroids administration to achieve early extubation (Giagliardi et al, 2007;Watterberg, 2006); the use of several pharmacologic agents as the inositol (Howlett & Ohlsson, 2003), the antiinflammatory recombinant protein "Clara" CC10 (Levine et al 2005), the antioxidant superoxide dismutase (Davis et al 2003); an optimal electrolyte balance; the early and intensive parenteral nutrition and enteral; and a fast diagnosis and treatment of chorioamnionitis and neonatal sepsis (Fahley et al, 2008).…”

Section: Early Ncpap and Niv In Infants Of Very Low Birth Weightmentioning

confidence: 99%

Quality and Safety in PICU and NICU: Scoreboard Control and Care Network

Fuster-Jorge¹,

Fernández-Sarabia²,

Delgado-Melián³

et al. 2011

Applications and Experiences of Quality Control

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“…4,5 However, permissive hypercapnia has not been shown to reduce BPD rates when examined in the absence of a ventilation strategy that is centered on avoidance of mechanical ventilation. 18,19 The opposite of permissive hypercapnia, hypocarbia, has been reported to increase BPD. 20 On the basis of adult studies 17 and several neonatal reports, 4,5,21 this PBP was assessed to rest on level 2 evidence and to be an important part of an overall strategy to reduce mechanical ventilation, tidal volumes, and BPD.…”

Section: Pbps Supported By Level 1 Evidencementioning

confidence: 99%

Evaluation and Development of Potentially Better Practices to Reduce Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

Payne¹,

LaCorte

Sun

et al. 2006

Pediatrics

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OBJECTIVE. The objective of this study was to describe development and implementation of potentially better practices to reduce bronchopulmonary dysplasia in very low birth weight infants (birth weight: 501-1500 g). METHODS.Results of Breathsavers Group meetings, conference calls and critically appraised topic summaries were used to construct potentially better practices. Implementation plans and experiences were reported by participants and collated.RESULTS. The Breathsavers Group developed 13 potentially better practices, based on published evidence and expert opinion. Participants determined which potentially better practices to implement and implementation methods. Participating NICUs implemented an average of 5 potentially better practices (range: 3-9). The Breathsavers Group also developed a resource kit, identified common obstacles to implementation, and initiated research to define bronchopulmonary dysplasia better.CONCLUSIONS. Multiinstitutional collaboration facilitated development and implementation of potentially better practices to reduce bronchopulmonary dysplasia. (NIC/Q 2002) to help participating NICUs make measurable improvements in care for very low birth weight (VLBW) infants. This collaborative was patterned after 2 previous collaboratives (NIC/Q and NIC/Q 2000). [1][2][3] The essential components of NIC/Q 2002 were (1) evidence-based potentially better practices (PBPs), (2) current methods of quality improvement and adult education, (3) multicenter collaboration, and (4) outcomes measurement. Central to the collaborative were 4 key habits: change, evidence-based practice, systems thinking, and collaborative learning. 3 Of centers that initially participated in NIC/Q 2002, 17 chose reducing bronchopulmonary dysplasia (BPD) as a primary objective and joined the Breathsavers Group. One institution dropped out of the collaborative, leaving 16 centers (19 hospitals) that completed the project. One center consisted of 4 separate hospitals that collaborated as a single center. Rates of BPD vary widely among centers, even after adjustment for differences in patient populations. 4,5 A previous report from the original NIC/Q collaborative showed a significant decrease in BPD among participants who focused on reducing BPD rates. 2 The Breathsavers Group believed that they could lower BPD rates by implementing PBPs. The goal was to reduce BPD by 10% in 2003 compared with the baseline year, 2001. METHODSThe Breathsavers Group consisted of 16 centers (19 hospitals) with Jay P. Goldsmith, MD, Medical Expert; Meena LaCorte, MD, Group Leader; and Debra Miller and Diane Miller, Facilitators. Participating hospitals are listed in the Acknowledgments. One center, Columbus Children's Hospital (Columbus, OH), was closely associated with 3 referral hospitals (Doctor's Hospital West, Riverside Methodist Hospital, and Grant Medical Center). These 4 hospitals worked very closely with each other and participated in the NIC/Q 2002 collaborative as a single center. For the purposes of this report, these 4 hos...

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Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants

Abstract: Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants.

Cited by 117 publications

References 25 publications

Strategies to minimize lung injury in extremely low birth weight infants

Strategies to minimize lung injury in extremely low birth weight infants

Quality and Safety in PICU and NICU: Scoreboard Control and Care Network

Evaluation and Development of Potentially Better Practices to Reduce Bronchopulmonary Dysplasia in Very Low Birth Weight Infants

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