Predictors of chronic lung disease in the ‘CPAP era’

Groves, Alan; Briggs, KA; Kuschel, CA; Harding, Jane E.

doi:10.1111/j.1440-1754.2004.00365.x

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…Indeed, a more recent comparison between two tertiary care neonatal centers suggested that, compared with conventional mechanical ventilation, the primary use of CPAP was associated with a lower incidence of bronchopulmonary dysplasia (65), a major cause of morbidity among neonatal intensive care survivors. Finally, current estimates suggest that CPAP is used in approximately one-half (and, especially in northern Europe, the majority) of preterm infants worldwide (18,28). Therefore, the compelling rationale for using CPAP is matched by strong evidence of its widespread use in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure causes lung injury in a model of sepsis

Tsuchida¹,

Engelberts²,

Roth³

et al. 2005

American Journal of Physiology-Lung Cellular and Molecular Phys

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-Continuous positive airway pressure, aimed at preventing pulmonary atelectasis, has been used for decades to reduce lung injury in critically ill patients. In neonatal practice, it is increasingly used worldwide as a primary form of respiratory support due to its low cost and because it reduces the need for endotracheal intubation and conventional mechanical ventilation. We studied the anesthetized in vivo rat and determined the optimal circuit design for delivery of continuous positive airway pressure. We investigated the effects of continuous positive airway pressure following lipopolysaccharide administration in the anesthetized rat. Whereas neither continuous positive airway pressure nor lipopolysaccharide alone caused lung injury, continuous positive airway pressure applied following intravenous lipopolysaccharide resulted in increased microvascular permeability, elevated cytokine protein and mRNA production, and impaired static compliance. A dose-response relationship was demonstrated whereby higher levels of continuous positive airway pressure (up to 6 cmH2O) caused greater lung injury. Lung injury was attenuated by pretreatment with dexamethasone. These data demonstrate that despite optimal circuit design, continuous positive airway pressure causes significant lung injury (proportional to the airway pressure) in the setting of circulating lipopolysaccharide. Although we would currently avoid direct extrapolation of these findings to clinical practice, we believe that in the context of increasing clinical use, these data are grounds for concern and warrant further investigation.lipopolysaccharide; spontaneous breathing; dexamethasone CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP), designed to recruit atelectatic lung (17), is widely employed for respiratory failure (49). CPAP delivered through a face mask is useful for a spectrum of acute respiratory failure in adults (7). Such "noninvasive" CPAP support can be applied outside of intensive care units, and clinical studies have demonstrated that it may reduce the need for invasive mechanical ventilation (57, 66) and lessen the incidence of sepsis-associated complications in high-risk postoperative adult patients (57). In preterm neonates, application of CPAP, sometimes for several weeks, may reduce the need for invasive mechanical ventilation, thereby lessening complications and associated costs of neonatal care. For such neonates, a particular type of CPAP, termed "bubble" CPAP, has been developed, whereby oscillatory vibrations developed by high flow of gas through the underwater seal are transmitted to the chest. Because such a system requires minimal equipment, bubble CPAP has immense appeal in terms of operational simplicity and economic cost. Indeed, for these reasons, it has been suggested that such CPAP would be ideal for use in developing countries (27). In fact, laboratory data support the clinical use of CPAP, because when compared with conventional ventilation, CPAP is associated with less inflammatory cytokine production (43) and a more normal pa...

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Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure causes lung injury in a model of sepsis

Tsuchida¹,

Engelberts²,

Roth³

et al. 2005

American Journal of Physiology-Lung Cellular and Molecular Phys

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“…Oxygen exposure is linked to the occurrence of BPD 3. Preterm human neonates have oxidant stress from birth, and animal data demonstrate poor antioxidant defences 4 5.…”

Section: Surviving Without Bronchopulmonary Dysplasiamentioning

confidence: 99%

“…Once extubated, apnoea/hypopnoea may limit the efficacy of NCPAP16 such that the lungs are not “opened up and kept open”,14 with atelectasis and desaturations increasing the Fi o 2 requirement. Given these limitations, early NCPAP use may not decrease BPD 3 41. For the VLBW infant at risk of BPD, the natural extension of NCPAP is NIPPV as it provides ventilatory support18–20 22 and interacts with the neonate’s coordinated laryngeal and diaphragmatic muscle activities that control EEV 42…”

Section: Physiological Considerationsmentioning

confidence: 99%

Non-invasive positive pressure ventilation in the preterm neonate: reducing endotrauma and the incidence of bronchopulmonary dysplasia

Hutchison

Bignall

2007

Arch Dis Child Fetal Neonatal Ed

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“…The etiology of BPD is multifactorial and includes lung immaturity, oxygen toxicity, baro‐/volu‐trauma, and infections. Even in the surfactant era, it still occurs in newborns, who needed little or no ventilatory support and low oxygen concentration 3 . The lung histology of “new BPD” infants involves milder injury and fibroproliferation, but is associated with the disruption of alveolar and vascular growth.…”

mentioning

confidence: 99%