What is new in ventilation strategies for the neonate?

Greenough, Anne; Sharma, Atul

doi:10.1007/s00431-007-0513-0

Cited by 13 publications

(7 citation statements)

References 57 publications

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“…In 2006, we initiated a new mode of ventilation, namely, volume-guarantee (VG) ventilation, which reduces large tidal volumes, decreases the incidence of inadvertent hyperventilation, reduces the duration of mechanical ventilation and pneumothorax [26], and reduces proinflammatory cytokine levels [11]. Furthermore, VG decreases the expression of early inflammatory markers to a greater extent than high-frequency oscillatory ventilation [27].…”

Section: Discussionmentioning

confidence: 99%

Trends in survival among extremely-low-birth-weight infants (less than 1000 g) without significant bronchopulmonary dysplasia

Botet

Miracle-Echegoyen

et al. 2012

BMC Pediatr

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ObjectiveThe aim of this study was to analyze the evolution from 1997 to 2009 of survival without significant (moderate and severe) bronchopulmonary dysplasia (SWsBPD) in extremely-low-birth-weight (ELBW) infants and to determine the influence of changes in resuscitation, nutrition and mechanical ventilation on the survival rate.Study designIn this study, 415 premature infants with birth weights below 1000 g (ELBW) were divided into three chronological subgroups: 1997 to 2000 (n = 65), 2001 to 2005 (n = 178) and 2006 to 2009 (n = 172).Between 1997 and 2000, respiratory resuscitation in the delivery room was performed via a bag and mask (Ambu®, Ballerup, Sweden) with 40-50% oxygen. If this procedure was not effective, oral endotracheal intubation was always performed. Pulse oximetry was never used. Starting on January 1, 2001, a change in the delivery room respiratory policy was established for ELBW infants. Oxygenation and heart rate were monitored using a pulse oximeter (Nellcor®) attached to the newborn’s right hand. If resuscitation was required, ventilation was performed using a face mask, and intermittent positive pressure was controlled via a ventilator (Babylog2, Drägger). In 2001, a policy of aggressive nutrition was also initiated with the early provision of parenteral amino acids. We used standardized parenteral nutrition to feed ELBW infants during the first 12–24 hours of life. Lipids were given on the first day. The glucose concentration administered was increased by 1 mg/kg/minute each day until levels reached 8 mg/kg/minute. Enteral nutrition was started with trophic feeding of milk. In 2006, volume guarantee treatment was instituted and administered together with synchronized intermittent mandatory ventilation (SIMV + VG). The complications of prematurity were treated similarly throughout the study period. Patent ductus arteriosus was only treated when hemodynamically significant. Surgical closure of the patent ductus arteriosus was performed when two courses of indomethacin or ibuprofen were not sufficient to close it.Mild BPD were defined by a supplemental oxygen requirement at 28 days of life and moderate BPD if breathing room air or a need for <30% oxygen at 36 weeks postmenstrual age or discharge from the NICU, whichever came first. Severe BPD was defined by a supplemental oxygen requirement at 28 days of life and a need for greater than or equal to 30% oxygen use and/or positive pressure support (IPPV or nCPAP) at 36 weeks postmenstrual age or discharge, whichever came first. Moderate and severe BPD have been considered together as “significant BPD”. The goal of pulse oximetry was to maintain a hemoglobin saturation of between 88% and 93%. Patients were considered to not need oxygen supplementation when it could be permanently withdrawn. The distribution of the variables was not normal based on a Kolmogorov-Smirnov test (p < 0.05 in all cases). Therefore, quantitative variables were expressed as the median and interquartile range (IQR; 25th-75th percentile). Statistical analysis of the data ...

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Section: Discussionmentioning

confidence: 99%

Trends in survival among extremely-low-birth-weight infants (less than 1000 g) without significant bronchopulmonary dysplasia

Botet

Miracle-Echegoyen

et al. 2012

BMC Pediatr

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“…Use of high-frequency oscillatory ventilation (HFOV) has been evaluated as both a mode of ventilation for prophylaxis against BPD and as a rescue mode for infants in severe respiratory failure. A meta-analysis of 11 trials comparing early use of HFOV to conventional ventilation showed a modest reduction in BPD but no statistically significant effect on mortality, short-term neurologic outcomes, ICH, or PVL [26]. However, many other recent studies have provided conflicting data [27][28][29].…”

Section: Why Prevention and Treatment Have Not Worked Thus Farmentioning

confidence: 99%

“…These conflicting data are likely to be due to differences in the study populations among various studies. HFOV has also been used as a rescue mode for infants in severe respiratory failure, but the evidence that this approach can reduce BPD or improve long-term outcomes in preterm infants is not yet available [18,26].…”

Section: Why Prevention and Treatment Have Not Worked Thus Farmentioning

confidence: 99%

Prevention and Treatment of Bronchopulmonary Dysplasia: Contemporary Status and Future Outlook

Cerný

Torday

Rehan

2008

Lung

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Despite tremendous advances in neonatology, bronchopulmonary dysplasia (BPD) remains a major cause of morbidity and mortality among premature infants. Any intervention that would reduce the risk of BPD or improve its outcome is likely to have substantial clinical and financial benefits. However, there is a clear lack of an effective agent for the treatment and/or prevention of BPD. This is due to an incomplete understanding of the molecular mechanisms involved in its pathogenesis. Taking a basic biological approach, our laboratory has discovered that disruption of normal alveolar homeostatic signaling is centrally involved in this process. Using a number of in vitro and in vivo models, our laboratory has demonstrated that stabilization of the normal alveolar homeostatic signaling pathway(s) can prevent and/or rescue the molecular injuries caused by the insults that lead to BPD. Here, we review the existing approaches to prevent and treat BPD and then, based on our insights into the pathogenesis of BPD, we propose novel and innovative therapeutic options that impact the disease on a cell/molecular level, unlike most of the current treatments available for BPD.

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“…Elective HFOV has been compared with conventional ventilation in a number of trials. Meta-analyses have shown a modest reduction in BPD in survivors at term with no significant effect on neurological adverse effects such as IVH or PVL [117,118]. There have only been two randomized controlled trials examining the efficacy of rescue HFOV and only one of these has included preterm infants.…”

Section: High Frequency Oscillation Ventilationmentioning

confidence: 95%

“…HFOV may be used electively or as rescue in response to severe respiratory failure during conventional ventilation. The concept of HFOV is that tiny gas volumes, less than anatomical dead space are moved in and out at rapid rates promoting assisted gas diffusion [48,118]. In animal models HFOV appears to be a less injurious mode of ventilation.…”

Section: High Frequency Oscillation Ventilationmentioning

confidence: 99%

Pathophysiology and Prevention of Bronchopulmonary Dysplasia

Davis¹

2008

CPR

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BPD is the major respiratory complication of preterm delivery and is typified by chronic oxygen dependency and respiratory insufficiency beyond 36 weeks' postconceptional age. It is caused by a combination of insults on the developing lung precipitated by preterm birth and its subsequent respiratory management. The common pathway linking the various causative factors is inflammation, which may be initiated prior to birth in the setting of maternal chorioamnionitis, or after birth by mechanical ventilation, infection or oxidative stress. Inflammation in the developing lung induces airways remodeling which adversely affects lung function. Multiple inflammatory mediators are implicated in this process and modifying the course of the disease has proven difficult. The emphasis of management should be directed towards prevention with strategies aimed at minimizing early lung injury and oxidative stress. These include delivery room stabilization and mechanical ventilation techniques that aim to avoid volutrauma and atelectotrauma. Drugs may also influence BPD progression and can broadly be divided into three categories; those administered prenatally to accelerate lung maturation, those administered postnatally to reduce initiation of inflammatory stimuli and those to modify any established inflammatory response. In this review we have examined recent evidence for each of these ventilatory and therapeutic strategies to prevent BPD. A better understanding of the pathophysiology of airways remodeling in BPD could have significant implications for future potential targeted interventions.

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What is new in ventilation strategies for the neonate?

Cited by 13 publications

References 57 publications

Trends in survival among extremely-low-birth-weight infants (less than 1000 g) without significant bronchopulmonary dysplasia

Trends in survival among extremely-low-birth-weight infants (less than 1000 g) without significant bronchopulmonary dysplasia

Prevention and Treatment of Bronchopulmonary Dysplasia: Contemporary Status and Future Outlook

Pathophysiology and Prevention of Bronchopulmonary Dysplasia

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