Prediction of prolonged ventilator dependence in preterm infants

Ali, Kamal; Kagalwalla, Sabena; Cockar, Iram; Williams, Emma; Tamura, Kentaro; Dassios, Theodore; Greenough, Anne

doi:10.1007/s00431-019-03394-9

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…However, in this clinical study V T was measured around 5-6 mL/kg for infants weighing less than 800 g. 34 Such relatively high V T might leave them prone to significant inflammation. 3 Thus, while CTGI is not a necessary condition for ventilating neonates, it offers an opportunity to reduce volutrauma and might consequently contribute to lung-protective strategies 36 in ventilated smaller neonates. 37 The other originality of this study lies in the tools developed to wash out the instrumental dead space: a simpler and easier-tomanufacture ETT, a CTGI flow generator adapted to health regulations, and a quieter, safer, and original humidification system using Nafion.…”

Section: Discussionmentioning

confidence: 99%

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Instrumental dead space: A glass ceiling for extremely low birth weight preterm infants? A dead space washout bench study

Danan

Tauzin

Jung

et al. 2023

Pediatric Pulmonology

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Background: When ventilating extremely low birth weight infants, clinicians face the problem of instrumental dead space, which is often larger than tidal volume.Hence, aggressive ventilation is necessary to achieve CO 2 removal. Continuous tracheal gas insufflation can wash out CO 2 from dead space and might also have an impact on O 2 and water vapor transport. The objective of this bench study is to test the impact of instrumental dead space on the transport of CO 2 , O 2 , and water vapor and the ability of continuous tracheal gas insufflation to remedy this problem during small tidal volume ventilation.Methods: A test-lung located in an incubator at 37°C was ventilated with pressure levels needed to reach different tidal volumes from 1.5 to 5 mL. End-tidal CO 2 at the test-lung exit, O 2 concentration, and relative humidity in the test-lung were measured for each tidal volume with and without a 0.2 L/min continuous tracheal gas insufflation flow.Results: CO 2 clearance was improved by continuous tracheal gas insufflation allowing a 28%-44% of tidal volume reduction. With continuous tracheal gas insufflation, time to reach desired O 2 concentration was reduced from 20% to 80% and relative humidity was restored. These results are inversely related to tidal volume and are particularly critical below 3 mL. Conclusion:For the smallest tidal volumes, reduction of instrumental dead space seems mandatory for CO 2 , O 2 , and water vapor transfer. Continuous tracheal gas insufflation improved CO 2 clearance, time to reach desired O 2 concentration and humidification of airways and, thus, may be an option to protect lung development.

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Section: Discussionmentioning

confidence: 99%

“…Such relatively high V T might leave them prone to significant inflammation 3 . Thus, while CTGI is not a necessary condition for ventilating neonates, it offers an opportunity to reduce volutrauma and might consequently contribute to lung‐protective strategies 36 in ventilated smaller neonates 37 …”

Section: Discussionmentioning

confidence: 99%

Instrumental dead space: A glass ceiling for extremely low birth weight preterm infants? A dead space washout bench study

Danan

Tauzin

Jung

et al. 2023

Pediatric Pulmonology

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“…[45][46][47] Conversely, fetal growth restriction has been associated with poor lung growth and function both in human and animal models. 1,45,46,[48][49][50][51] It is possible that lung growth with increasing age resulted in increase in alveolar surface area and thinning of the interstitium, allowing for improved gas exchange.…”

Section: Discussionmentioning

confidence: 99%

Transcutaneous carbon dioxide pattern and trend over time in preterm infants

et al. 2021

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BACKGROUND: Chronic lung disease remains a burden for extremely preterm infants. The changes in ventilation over time and optimal ventilatory management remains unknown. Newer, non-invasive technologies provide insight into these patterns. METHODS: This single-center prospective cohort study enrolled infants ≤32 0/7 weeks. We obtained epochs of transcutaneous carbon dioxide (TcCO 2 ) measurements twice each week to describe the pattern of hypercarbia throughout their hospitalization. RESULTS: Patterns of hypercarbia varied based on birth gestational age and post-menstrual age (PMA) (p = 0.03), regardless of respiratory support. Infants receiving the most respiratory support had values 16-21 mmHg higher than those on room air (p < 0.001). Infants born at the youngest gestational ages had the greatest total change but the rate of change was slower (p = 0.049) compared to infants born at later gestational ages. All infants had TcCO 2 values stabilize by 31-33 weeks PMA, when values were not significantly different compared to discharge. No rebound was observed when infants weaned off invasive support. CONCLUSIONS: Hypercarbia improves as infants approached 31-33 weeks PMA. Hypercarbia was the highest in the most immature infants and improved with age and growth despite weaning respiratory support.

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“…Identifying this latter group of infants can be difficult as the neonate's clinical course evolves during the first weeks of life. In a recent retrospective study of 41 infants born before 32 weeks PMA, low birth weight and gestational age were most strongly associated with mechanical ventilation at 28 days 17 . However, those who remained ventilated were also observed to have higher tidal volumes, peak inspiratory pressures, and minute volumes during the first 24 h of life, suggesting that early volutrauma may contribute to the development of chronic ventilator dependence.…”

Section: Identifying Chronic Respiratory Failure In Infants With Bpdmentioning

confidence: 99%

Chronic respiratory failure in bronchopulmonary dysplasia

Baker

2021

Pediatric Pulmonology

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Although survival has improved dramatically for extremely preterm infants, those with the most severe forms of bronchopulmonary dysplasia (BPD) fail to improve in the neonatal period and go on to develop chronic respiratory failure. When careful weaning of respiratory support is not tolerated, the difficult decision of whether or not to pursue chronic ventilation via tracheostomy must be made. This requires shared decision‐making with an interdisciplinary medical team and the child's family. Although they suffer from increased morbidity and mortality, the majority of these children will survive to tolerate ventilator liberation and tracheostomy decannulation. Care coordination for the technology‐dependent preterm infant is complex, but there is a growing consensus that chronic ventilation can best support neurodevelopmental progress and improve long‐term outcomes.

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Prediction of prolonged ventilator dependence in preterm infants

Cited by 13 publications

References 23 publications

Instrumental dead space: A glass ceiling for extremely low birth weight preterm infants? A dead space washout bench study

Instrumental dead space: A glass ceiling for extremely low birth weight preterm infants? A dead space washout bench study

Transcutaneous carbon dioxide pattern and trend over time in preterm infants

Chronic respiratory failure in bronchopulmonary dysplasia

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