Means Of Respiratory Support Research Articles

Nasal high-frequency jet ventilation (NHFJV) as a novel means of respiratory support in extremely low birth weight infants.

ObjectiveDescribe our experience of successfully using nasal high-frequency jet ventilation (NHFJV) in extremely low birth weight infants with respiratory failure.Study designA retrospective review was conducted on 16 infants with birth weights <1000 g who received NHFJV from 2015 to 2019. Successful use was defined as avoiding intubation for at least 72 hours and demonstrating tolerance after being placed on NHFJV.ResultsMedian gestational age was 24.5 weeks (IQR 24, 25), and weight at the start of NHFJV 1090 g (IQR 905, 1250). NHFJV was used successfully in 13/16 (81%) infants with a median duration of 7 days (IQR 3, 12). Days on invasive (30 vs. 186) and noninvasive (46 vs. 81) ventilation were shorter when compared to those who failed the use of NHFJV.ConclusionThis is the first reported case series for the successful use of NHFJV. Our study highlights the feasibility of a potential new mode of noninvasive respiratory support.

Multi-omics reveals age-related differences in the diaphragm response to mechanical ventilation: a pilot study

BackgroundOld age is associated with a significantly increased mortality in COVID-19 patients exposed to long-term controlled mechanical ventilation (CMV) and suggested to be due to the hyperinflammatory response associated with the viral infection. However, our understanding of age-related differences in the response to CMV in the absence of a viral infection remains insufficient.MethodsYoung (7–8 months) and old (28–32 months) F344 BN hybrid rats were exposed to the ICU condition for 5 days, i.e., complete immobilization, mechanical ventilation, and extensive monitoring. Transcriptomic (RNA-Seq) and proteomics (Proximity Extension Assay) analyses of the diaphragm and proteomics analysis of plasma were conducted to investigate the molecular differences between young and old rats exposed to the ICU condition.ResultsAccording to multi-omics analyses, significant differences were observed in the diaphragm between young and old rats in response to 5 days CMV and immobilization. In young rats, metabolic pathways were primarily downregulated in response to immobilization (post-synaptic blockade of neuromuscular transmission). In old rats, on the other hand, dramatic immune and inflammatory responses were observed, i.e., an upregulation of specific related pathways such as “IL-17 signaling pathway”, along with a higher level of inflammatory factors and cytokine/chemokine in plasma.ConclusionsThe dramatically increased mortality in old ICU patients with COVID-19-associated hyperinflammation and cytokine storm need not only reflect the viral infection but may also be associated with the ventilator induced diaphragm dysfunction (VIDD) and hyperinflammatory responses induced by long-term CMV per se. Although mechanical ventilation is a life-saving intervention in COVID-19 ICU patients, CMV should be cautiously used especially in old age and other means of respiratory support may be considered, such as negative pressure ventilation.

English

BACKGROUND Neonatal respiratory distress syndrome (RDS) is among the common complications in infants born before 37 weeks. In India the incidence of RDS ranges from 0.69 - 8.3 %. CPAP is a less invasive method frequently used in premature infants having RDS). We wanted to assess the outcome of preterm neonates treated with CPAP. METHODS Prospective observational study was done in NICU of a tertiary care hospital, Raipur, Chhattisgarh in central India, during April-2014 to April-2015. Eligible Children were included in the study and evaluated using SAS (Silverman Anderson Scoring), blood gas analysis and pulse oximetry. Quantitative variables were presented as mean and standard deviation; categorical variables were presented as frequency and percentages. RESULTS Out of total 50 babies on CPAP, 38 improved with success rate of 76 % whereas 12 babies (24 %) failed requiring higher mode of ventilation. CPAP was more successful among females (n = 22) with a success rate of 88.0 %. CPAP proved more effective in moderate grade RDS with success rate of 83.3 % (statistically significant p &lt; 0.05). Based on SAS score, shows the improvement in respiratory distress following CPAP. CONCLUSIONS Nasal CPAP is safe effective, non-invasive means of respiratory support in RDS. It can considerably decrease the requirement for mechanical ventilation (MV) and surfactant therapy. KEYWORDS Respiratory Distress Syndrome, Positive Airway Pressure, Silverman Anderson Score

Effect of Nursing Protocol Regarding Nasal Skin Breakdown for Preterm Infants Receiving Continuous Positive Airway Pressure

Context: Neonates, particularly those who are born premature, may require ventilation assistance immediately after birth, since their lung may not be fully developed. The use of nasal continuous positive airway pressure (CPAP) is increasing as a means of respiratory support in many premature infants. So, the presence of nasal skin breakdown may be seen as a complication.&#x0D; Aim: To evaluate the effect of nursing protocol regarding nasal skin breakdown for preterm infants receiving nasal continuous positive airway pressure (CPAP).&#x0D; Methods: A quasi-experimental research design utilized to conduct the current study. The study conducted at Neonatal Intensive Care Units (NICUs) and Surgical Neonatal Intensive Care Unit "SNICU" of Benha Specialized Pediatric Hospital at Benha city. A convenient sample of nurses (70) working in NICU sand SNICU and a purposive random sample of (77) preterm infants included from the settings mentioned above. Those premature infants were divided into two groups (study and control) (35) in the control group and (42) in the study group, who selected according to the power analysis equation based on the total number of preterm infants who admitted to the setting mentioned above during 2017. Three tools used. A structured interviewing questionnaire sheet designed to assess nurses’ sociodemographic characteristics, and nurses' knowledge regarding CPAP, care provided to preterm infants undergoing CPAP, and nasal skin breakdown. The second tool was a nursing practice observation checklist to assess nurses' practice regarding nasal CPAP. The third tool was Preterm Medical Assessment Record. It designed to assess the characteristics of preterm infants and medical data of preterm infants. The last tool was the Neonatal Skin Condition Score (NSCS) scale that is designed to assess the neonates’ skin condition.&#x0D; Results: Findings of the present study revealed a statistically significant difference (P&lt;0.05) pre and post nursing protocol implementation regarding CPAP, the role of the nurse caring for preterm infants undergoing nasal CPAP, and nasal skin breakdown. The results also revealed a highly statistically significant difference in nursing practice regarding care for preterm infants undergoing nasal CPAP pre and post nursing protocol implementation at (p&lt;0.001). Nasal Skin Breakdown in the study group was significantly less than in the control group at a different time of assessment at (p˂0.001).&#x0D; Conclusion: It can be concluded that the research hypothesis is accepted, nursing protocol implemented for nurses improved their knowledge and practice as well as reduced nasal skin breakdown in the preterm newborns receiving NCPAP. The study recommended applying the nursing protocol for nurses caring for preterm infants to reduce nasal skin breakdown during CPAP ventilation, which is an effective and safe non-invasive intervention in all NICUs as a standard of care for all preterm infants.

Acute In Vivo Evaluation of the Pittsburgh Pediatric Ambulatory Lung.

Respiratory failure is a significant problem within the pediatric population. A means of respiratory support that readily allows ambulation could improve treatment. The Pittsburgh Pediatric Ambulatory Lung (P-PAL) is being developed as a wearable pediatric pump-lung for long-term respiratory support and has previously demonstrated positive benchtop results. This study aimed to evaluate acute (4-6 hours) in vivo P-PAL performance, as well as develop an optimal implant strategy for future long-term studies. The P-PAL was connected to healthy sheep (n = 6, 23-32 kg) via cannulation of the right atrium and pulmonary artery. Plasma-free hemoglobin (PfHb) and animal hemodynamics were measured throughout the study. Oxygen transfer rates were measured at blood flows of 1-2.5 L/min. All animals survived the complete study duration with no device exchanges. Flow limitation because of venous cannula occlusion occurred in trial 2 and was remedied via an altered cannulation approach. Blood exiting the P-PAL had 100% oxygen saturation with the exception of trial 4 during which inadequate device priming led to intrabundle clot formation. Plasma-free hemoglobin remained low (<20 mg/dl) for all trials. In conclusion, this study demonstrated successful performance of the P-PAL in an acute setting and established the necessary methods for future long-term evaluation.

A pilot study of improvised CPAP (iCPAP) via face mask for the treatment of adult respiratory distress in low-resource settings

BackgroundContinuous positive airway pressure (CPAP) is a mode of non-invasive ventilation used to treat a variety of respiratory conditions in the emergency department and intensive care unit. In low-resource settings where ventilators are not available, the ability to improvise a CPAP system from locally available equipment would provide a previously unavailable means of respiratory support for patients in respiratory distress. This manuscript details the design of such a system and its performance in healthy volunteers.MethodsAn improvised CPAP system was assembled from standard emergency department equipment and tested in 10 healthy volunteers (6 male, 4 female; ages 29–33). The system utilizes a water seal and high-flow air to create airway pressure; it was set to provide a pressure of 5 cmH2O for the purposes of this pilot study. Subjects used the system in a monitored setting for 30 min. Airway pressure, heart rate, oxygen saturation, and end-tidal CO2 were monitored. Comfort with the device was assessed via questionnaire.ResultsThe system maintained positive airway pressure for the full trial period in all subjects, with a mean expiratory pressure (EP) of 5.1 cmH2O (SD 0.7) and mean inspiratory pressure (IP) of 3.2 cmH2O (SD 0.8). There was a small decrease in average EP (5.28 vs 4.88 cmH2O, p = 0.03) and a trend toward decreasing IP (3.26 vs 3.07 cmH2O, p = 0.22) during the trial. No significant change in heart rate, O2 saturation, respiratory rate, or end-tidal CO2 was observed. The system was well tolerated, ranked an average of 4.0 on a 1–5 scale for comfort (with 5 = very comfortable).ConclusionsThis improvised CPAP system maintained positive airway pressure for 30 min in healthy volunteers. Use did not cause tachycardia, hypoxia, or hypoventilation and was well tolerated. This system may be a useful adjunctive treatment for respiratory distress in low-resource settings. Further research should test this system in settings where other positive pressure modalities are not available.

High-flow nasal cannula oxygen therapy: An alternative means of respiratory support for critically ill patients

High-flow nasal cannula oxygen therapy: An alternative means of respiratory support for critically ill patients

Humidified high flow nasal cannulae: Current practice in Australasian nurseries, a survey

Humidified High Flow Nasal Cannula (HHFNC) has been increasingly adopted as a new means of respiratory support throughout the world. However, evidence to support its safety and efficacy is limited. The aim of the present survey was to determine current practices regarding the usage of HHFNC by neonatologists in Australia and New Zealand. Surveys were sent to all 167 neonatologists identified by the list of centres in the Australia and New Zealand Neonatal Network. A total of 157 surveys were sent to valid email addresses: 111 (71%) responded of which 105 (67%) had completed the questionnaire. HHFNC is used in 17 (63%) of neonatal intensive care units in Australia and New Zealand. It is most commonly used to reduce nasal trauma (91%) and provide continuous positive airways pressure (62%). The main perceived benefits of HHFNC were the easier application and care of the infant (86%), and improved tolerance by the baby (84%). Rain out leading to fluid instillation into the upper airway (59%) was the most common problem. This survey has provided a snapshot of the practice of HHFNC usage in Australia and New Zealand in 2010 and has revealed that HHFNC use is widespread and that clinical practices are diverse. The majority of neonatologists acknowledge that there is limited evidence to support its efficacy and safety, and would be happy to participate in clinical trials to address how best to deliver HHFNC.

Use of nasal continuous positive airway pressure during neonatal transfers

Objective: To review all cases in which nasal continuous positive airway pressure (CPAP) was used as a means of respiratory support during land based ambulance transfers by a regional neonatal...

The effects of positive and negative extrathoracic pressure ventilation on pulmonary blood flow after the total cavopulmonary shunt procedure

Pulmonary blood flow patterns were studied during the application of varying extrathoracic pressure in 2 patients after total cavopulmonary anastomosis. The application of negative extrathoracic pressure was associated with large increases in pulmonary blood flow, while positive extrathoracic pressure, caused retrograde flow away from the lungs. These preliminary observations suggest that negative extrathoracic pressure may be useful as a means of respiratory support in patients after right heart bypass procedures.

Trauma to the Thorax and Abdomen.

This volume is intended to assist the busy surgeon who must make immediate decisions in the management of the acutely injured, and accomplishes the objective quite well. Most of the experience is drawn from the clinical services at Grady Memorial Hospital and data from that experience is clearly set forth in supporting the author's rationale of treatment. The first chapter dealing with pathophysiology of trauma is excellent and the second concerning mechanisms is unique, though of limited immediate value. The x-ray films obviously were carefully selected and reproduced with remarkable clarity. The illustrations and line drawings are abundant, appropriate, and readily understandable. The text suffers somewhat from too much fragmentation in that the chapters are separated by anatomical divisions rather than by system involvement or larger anatomical divisions corresponding more to clinical experience. It is particularly disappointing to read practically nothing on the use of ventilators, means of respiratory support,