Occurrence Of Air Leaks Research Articles

Inspiratory training and immediate lung recovery after resective pulmonary surgery: a randomized clinical trial.

BackgroundPrompt and uneventful recovery after resective pulmonary surgery benefits patients by decreasing length and total costs of hospital stay. Postoperative physiotherapy has been shown to be advantageous for patient recovery in several studies and lately inspiratory muscle training (IMT) physiotherapy has been used also in thoracic patients. This randomized controlled trial intended to evaluate whether IMT is an efficient and feasible method of physiotherapy compared to water bottle positive expiratory physiotherapy (PEP) immediately after lung resections.MethodsForty-two patients were randomly allocated into two intervention groups: water bottle PEP (n=20) and IMT group (n=22). Patients were given physiotherapeutic guidance once a day and patients were also instructed to do independent exercises. Measurements of pulmonary function were compared between the treatment groups according to intention to treat by using two-way repeated measures analysis of variances at three time points (preoperative, first postoperative day, and second postoperative day). Walking distance was measured at first and second postoperative day and similarly, evaluation of postoperative air leak during exercises was performed. Physiotherapy was modified or temporarily interrupted, if necessary, because of the air leak.ResultsPostoperative pulmonary function tests were equal between the intervention groups. Air leak was relatively common after lung resections: 31% of all patients had mild or moderate/severe air leak at first postoperative day and 14% of all patients had mild to severe air leak at second postoperative day respectively. There were no statistically significant differences in occurrence of air leak between intervention groups, but water resistance had to be reduced or physiotherapy discontinued significantly more often among the water bottle PEP group patients (P=0.01). Walking distance improved slightly faster in the IMT group between the first and the second postoperative day when compared to the water bottle PEP group, but the difference between the groups was not statistically significant.ConclusionsIMT physiotherapy is equally effective to water bottle PEP training in postoperative physiotherapy after lung resection surgery evaluated with pulmonary function tests and walking distance. In addition, IMT physiotherapy is safe and more feasible form of physiotherapy during postoperative air leak compared to water bottle PEP.

Perinatal events predicting retinopathy of prematurity in extremely pre-term infants.

Extremely preterm infants are peculiar in regard to their risk of retinopathy of prematurity (ROP). In this study, we aim to study insults that may affect extremely preterm infants, including prenatal, at birth, and postnatal insults and their effect on the development of ROP. This study used the data from Prematurity and Respiratory Outcomes Program (PROP). All included infants with a gestational age of 23 0/7 to 28 6/7 weeks using best obstetrical estimate. We included stressful events and/or modifiable variables that may affect the normal development. We used multiple regression analysis in our statistical analysis. We included a total of 751 infants in our study. The mean birth weight for the included sample was 915.1 (±232.94) grams. 391 (52.1%) Infants were diagnosed with ROP. We found a significant negative correlation between ROP development and birth weight (p < 0.001), with a correlation coefficient of - 0.374. We found that the need for prophylactic indomethacin (OR 1.67), the occurrence of air leaks (OR: 2.35), ventilator-associated pneumonia (OR: 2.01), isolated bowel perforations (OR: 3.7), blood culture-proven sepsis (OR: 1.5), other infections (OR: 1.44), and receiving ventricular shunt (OR: 2.9) are significantly associated with the development of ROP. We believe this study included the largest number of factors studied in the largest sample of extremely premature infants. We recommend a screening program for extremely preterm infants that takes into account a scoring system with higher scores for complicated condition.

Nasal CPAP vs Bi-level Nasal CPAP in preterms with RDS: a randomized control study

Background: Ventilator induced lung injury prevention may begin from birth, and respiratory support without endotracheal intubation is an attractive option in preterm baby with Respiratory distress syndrome (RDS). The objective of the study was to evaluate the clinical course and respiratory outcomes in preterm infants with moderate RDS assigned from birth to Nasal Continuous Positive Airway Pressure (NCPAP) or Bi-level Nasal Continuous Positive Airway Pressure (Bi-level NCPAP).Methods: 60 infants of 28-34 weeks GA (&lt;35 wks GA), affected by moderate RDS, were considered eligible and were randomized to NCPAP (CPAP level=6cm H2O, Group A n=30) or to Bi-level NCPAP (lower CPAP level=4.5 cmH2O; higher CPAP level=8 cmH2O, Group B n=30), provided with the variable flow devices (Infant Flow CPAP vs Infant Flow SiPAP™, Viasys Healthcare, Yorba Linda, CA).Results: Length of ventilation, oxygen dependency, need for intubation and occurrence of air leaks were considered as outcomes. Infants showed similar characteristics at birth (Group A versus Group B: GA 30.4±2 wks versus 30.3±2wks, BW 1433±545g versus 1415±560g. Group A underwent longer respiratory support (6,2±2 days versus 3,8±1 days, p=0.025), longer O2 dependency (13,8±8 days versus 6,5±4 days, p=0.027) and was discharged later (GA at discharge 36,7±2,5 weeks versus 35,6±1,2 weeks, p=0.02). All infants survived. No BPD or neurological disorders occurred.Conclusions: Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, and allowed earlier discharge, inducing the same changes in the cytokine levels. In our population, it was well tolerated and safe

Current methodological and technical limitations of time and volumetric capnography in newborns.

Although capnography is a standard tool in mechanically ventilated adult and pediatric patients, it has physiological and technical limitations in neonates. Gas exchange differs between small and adult lungs due to the greater impact of small airways on gas exchange, the higher impact of the apparatus dead space on measurements due to lower tidal volume and the occurrence of air leaks in intubated patients. The high respiratory rate and low tidal volume in newborns, especially those with stiff lungs, require main-stream sensors with fast response times and minimal dead-space or low suction flow when using side-stream measurements. If these technical requirements are not fulfilled, the measured end-tidal CO2 (PetCO2), which should reflect the alveolar CO2 and the calculated airway dead spaces, can be misleading. The aim of this survey is to highlight the current limitations of capnography in very young patients to avoid pitfalls associated with the interpretation of capnographic parameters, and to describe further developments.

Nasal continuous positive airway pressure (CPAP) versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome: a randomised control trial

ObjectiveTo evaluate the clinical course, respiratory outcomes and markers of inflammation in preterm infants with moderate respiratory distress syndrome (RDS) assigned from birth to nasal continuous positive airway pressure (NCPAP)...

Oesophageal perforation in preterm neonates: not an innocent bystander.

To compare the clinical course and neonatal outcomes of preterm infants with oesophageal perforation (OP). Retrospective case control study of infants admitted between 1994 and 2001 and diagnosed with OP was performed at two tertiary care centres in Toronto, Canada. One control per case was matched by the gestational age and the month of birth. Occurrence of air leak syndrome/pleural effusion requiring drainage, the duration of supplemental oxygen and the time to attain full feeds were compared. Ten cases of OP were identified. The commonest clinical presentation was air leak syndrome/pleural effusion. There was a statistically significant increase in the time to attain full enteral feeds in OP group (P = 0.02). The duration of supplemental oxygen was prolonged in infants with OP, however, this was statistically insignificant (P = 0.20). The infants were managed conservatively and perforation healed in all. Oesophageal perforation is a rare but important complication of modern neonatal intensive care setting. The diagnosis of OP should be considered in infants who present with sudden/acute deterioration in their respiratory status following procedures involving pharyngeal region. Conservative management in an otherwise uncomplicated case leads to complete recovery in neonates.

High-Frequency Jet Ventilation in the Early Management of Respiratory Distress Syndrome Is Associated With a Greater Risk for Adverse Outcomes

The objective of this investigation was to determine if high-frequency jet ventilation (HFJV) used early in the treatment of premature infants with respiratory distress syndrome was effective in reducing pulmonary morbidity without increasing the occurrence of adverse neurologic outcomes. A total of 73 premature infants who met the inclusion criteria (gestational age of less than 33 weeks, birth weight of more than 500 g, age of less than 24 hours, need for assisted ventilation with peak inspiratory pressure of more than 16 and FIO2 more than 0.30, and roentgenographic evidence of respiratory distress syndrome) were randomized to either conventional (n = 36) or to high-frequency jet (n = 37) ventilation. Our goals were to maintain the infants on the assigned ventilator for at least 7 days unless they could either be extubated or meet crossover criteria. Univariate analyses were initially used to compare the two groups. Stepwise logistic regression was subsequently used to assess whether various factors independently influenced adverse outcomes. The two groups of infants were similar in all obstetrical, perinatal, and neonatal demographic characteristics. The mean birth weight and gestational age in the conventional group were 930 g and 26.6 weeks and in the HFJV group, 961 g and 26.9 weeks. The infants were randomized at similar ages (7.1 and 7.3 hours of life, respectively). Their prerandomization ventilator settings and arterial blood gases were nearly identical. There were no differences in pulmonary outcomes (occurrence of air leaks, need for oxygen or ventilation at 36 weeks postconception), and there were no differences in the mean number of days oxygen was required, number of days ventilated, or length of hospital stay. Infants ventilated with HFJV were significantly more likely to develop cystic periventricular leukomalacia (10 vs 2, P = .022) or to have a poor outcome (grade IV hemorrhage, cystic periventricular leukomalacia, or death) (17 vs 7, P = .016). Logistic regression analysis revealed HFJV to be a significant independent predictor of both cystic periventricular leukomalacia and a poor outcome. The presence of hypocarbia was not an independently significant predictor of adverse outcomes. With the HFJV treatment strategy that we used, use of the high-frequency jet ventilator in the early management of premature infants with respiratory distress syndrome resulted in significantly more adverse outcomes than in those treated with conventional mechanical ventilation.