Physiologic Principles

Keszler, Martin; Abubakar, Kabir

doi:10.1016/b978-0-323-39006-4.00002-8

Cited by 11 publications

(7 citation statements)

References 106 publications

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“…However, FETO patients showed a more negative mean Z-Score V T , which means that the observed tidal volume generally deviated from the normal expected value more so than what was observed in non-FETO patients, probably due to their worse initial clinical conditions. Considering the inverse correlation between RR and V T, the higher respiratory rates observed in the FETO group could represent a physiological mechanism aimed at compensating for a reduction in tidal volumes in an attempt to maintain adequate minute ventilation (31). Finally, when considering FETO and non-FETO groups separately, the link between radiological and respiratory parameters disappeared, except for total lung area and V T in the untreated group.…”

Section: Comparison Between Feto and Non-feto Patientsmentioning

confidence: 95%

The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia

et al. 2020

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Section: Comparison Between Feto and Non-feto Patientsmentioning

confidence: 95%

The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia

et al. 2020

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“…This leads to regionally different rates of filling and emptying within the lung, described by regional time constants. It takes one time constant to empty any compartment by ~63% and three time constants are necessary to empty the compartment by 95% . The marked heterogeneity of disease in the BPD lung suggests that time constants of various lung units differ regionally, with some filling and emptying much more slowly than others.…”

Section: Discussionmentioning

confidence: 99%

Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia

Napolitano

Jalal

McDonough

et al. 2019

Pediatric Pulmonology

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Rationale: Infants with severe bronchopulmonary dysplasia (sBPD) and airway obstruction may develop dynamic hyperinflation and intrinsic positive end-expiratory pressure (PEEP i ), which impairs patient/ventilator synchrony.Objectives: To determine if PEEP i is present in infants with sBPD during spontaneous breathing and if adjusting ventilator PEEP improves patient/ventilator synchrony and comfort.Methods: Interventional study in infants with sBPD. PEEP i measured by esophageal pressure (Pes) and pneumotachometer, during pressure-supported breaths. PEEP i defined as the difference between Pes at start of the inspiratory effort minus Pes at onset of inspiratory flow. The set PEEP was adjusted to minimize PEEP i . "Best PEEP" was the setting with minimal wasted efforts (WE), an inspiratory effort seen on the Pes waveform without a corresponding ventilator breath. FiO 2 and SpO 2 measured pre-and post-PEEP adjustment. Sedation requirements evaluated 72 hours preprocedure and postprocedure.Results: Twelve infants were assessed (gestational age, 24.9 ± 1.4 weeks; study age, 48.8 ± 1.5 weeks, postmenstrual age). Mean baseline ventilator PEEP was 16.4 cm H 2 O (14-20 cm H 2 O). Eight infants required an increase, one, a reduction, and three, no change in the set PEEP. For the eight infants requiring an increase in set PEEP, there was an 18.9% reduction in WE and a reduction in FiO 2 (0.084 ± 0.058) requirements in the subsequent 24 hours. Conditional sedation was reduced in five infants postprocedure. No adverse events occurred during testing.Conclusion: PEEP i is measurable in infants with sBPD with concurrent esophageal manometry and flow-time tracings without the need for pharmacological paralysis. In those with PEEP i , increasing ventilator PEEP to offset PEEP i improves synchrony. K E Y W O R D S bronchopulmonary dysplasia, critical care, mechanical ventilation

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“…Various forms of HFV have been used to treat infants with pulmonary air leak and the superiority of this type of ventilation over conventional ventilation has been shown [ 9 ]. It is not clear how HFV improves the healing of air leaks, but a ventilator strategy incorporating short inspiratory time and high respiratory rates is often effective in decreasing the magnitude of the leak [ 7 , 8 , 10 ]. It is most likely that the absence of high-peak inspiratory pressures, the very short absolute inspiratory time and small tidal volume applied at higher frequencies may result in a rapid decrease of air leak, as showed by Ellsbury et al in an animal model of pneumothorax [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: report of five cases

et al. 2017

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BackgroundDespite an increased use of non-invasive ventilatory strategies and gentle ventilation, pneumothorax remains a common complication in preterm infants. The ventilator management of infants with air leaks remains challenging in terms of both prevention and treatment. Recently the safety and efficacy of expectant management avoiding chest tube drainage to treat large air leak in preterm infants hemodynamically stable has been reported.Case presentationIn the present study, we report five cases of preterm infants with birth weight ≤ 1250 g affected by respiratory distress syndrome and treated with nasal continuous positive airway pressure as first intention. They were intubated for worsening of respiratory distress with increasing oxygen requirement and concomitant increase of respiratory rate and PCO2 values due to occurrence of pneumothorax, and they were successfully treated using high-frequency oscillatory ventilation without chest tube insertion.ConclusionIn our experience high-frequency oscillatory ventilation provided a conservative management of a significant pneumothorax in preterm newborns hemodynamically stable and requiring mechanical ventilation. This approach allowed us to avoid the increasing of air leak and the insertion of chest tube drainage and all the subsequent associated risks.

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Physiologic Principles

Cited by 11 publications

References 106 publications

The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia

The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia

Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia

Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: report of five cases

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