Ventilated Newborn Infants Research Articles

Non-invasive high-frequency ventilation in newborn infants with respiratory distress.

Non-invasive high-frequency ventilation in newborn infants with respiratory distress.

Heliox for prevention of morbidity and mortality in ventilated newborn infants

Heliox for prevention of morbidity and mortality in ventilated newborn infants

Mechanical Ventilation Trigger Tool Identify Errors Associated with Mechanical Ventilation in Newborn Infant

BACKGROUND: Patient safety is the core of quality of health care. Newborn infants who are admitted to NICU are liable to adverse events. Medical errors represent a serious public health problem and pose a threat to patient safety. Mechanical ventilation is a complex procedure that exposes newborn infants to adverse events and complications. AIM: The objective of this study was to identify medical errors related to mechanical ventilation (MV) in newborn infants using the newly design MV trigger tool. METHODS: Observational cohort study was conducted for 6-month duration to determine the medical errors related to mechanical ventilation. It was carried out on newborn infants who needed mechanical ventilation and admitted to the NICU. Furthermore, we used the mechanical ventilation trigger tool to estimate number, types, and risk factors for the related errors. RESULTS: There were 142 errors related to mechanical ventilation. Nearly 21.13% of the errors were related to ventilator settings, 38.39% were related to endotracheal intubation, and 40.14% of the errors were due to manipulation of the ventilators. The adverse events were diagnosed in 73.24% of the detected errors. Error of commission was seen in 53.5% of cases, and omission errors were reported in 46.5% of the cases. Mechanical ventilation trigger tool has 95.87% sensitivity and 95.24% specificity with 95.77% accuracy to detect errors. CONCLUSION: The mechanical ventilation trigger tool may be efficient and effective in identifying errors and adverse events related to mechanical ventilation; it has high sensitivity and specificity. It might increase awareness to improve MV-related care.

One-person versus two-person mask ventilation in preterm infants at birth: a pilot randomised controlled trial

BackgroundMask leak and airway obstruction are common with mask ventilation in newborn infants, leading to suboptimal ventilation. We aimed to perform a pilot study measuring respiratory mechanics during one-person and...

Lung Ultrasound Monitoring of Legionella Ventilator-Associated Pneumonia in an Extremely Low-Birth-Weight Infant.

Ventilator-associated pneumonia (VAP) is a common complication of different severe lung diseases that need to be treated with mechanical ventilation in newborn infants. However, VAP due to Legionella pneumophila infection is rarely reported in the literature, especially in extremely low-birth-weight (ELBW) infants. Lung ultrasound (LUS) has been used in the diagnosis of neonatal pneumonia, but there is no literature on the ultrasound characteristics of Legionella-VAP in ELBW infants. This paper introduced the typical LUS findings of Legionella-VAP in ELBW infants, which mainly includes severe and large-area lung consolidation and atelectasis in the bilateral lungs; whether there is blood supply in the consolidated area has an important reference value for predicting the prognosis. In addition, the treatment and management experience were also introduced together, thereby helping us to deepen the understanding of the disease and avoid missed diagnoses.

Heliox for prevention of morbidity and mortality in ventilated newborn infants

Heliox for prevention of morbidity and mortality in ventilated newborn infants

Volumetric capnography slopes in ventilated term and preterm infants

Objective: To assess whether the slopes of volumetric capnography differ in preterm compared to term-born ventilated newborn infants and whether they are related to gestational age and the duration of ventilation. Approach: The slopes of phase II (SII) and III (SIII) of volumetric capnographs were measured in ventilated term and preterm infants at King’s College Hospital NHS Foundation Trust. The correlations of the slopes with gestational age (GA), duration of invasive ventilation and fraction of inspired oxygen (FIO2) were assessed. The slopes were normalised by multiplying the results with the expiratory tidal volume (VT) measurement. Main results: Fifty-six infants (44 preterm) were assessed. The preterm infants had a median (IQR) gestational age of 26 (25–29) weeks and were ventilated for 8 (3–32) days with a VT of 5.4 (4.1–6.8) ml kg−1. The term infants had a gestational age of 39 (37–40) weeks and were ventilated for 1 (1–6) day with a VT of 4.0 (3.6–5.3) ml kg−1. The SII (85.9 (76.2–98.4) mmHg) and SIII (16.5(10.0–21.9) mmHg) of the preterm infants were not significantly different compared to the SII (88.0 (74.6–110.0) mmHg) and SIII (13.5 (9.2–15.9) mmHg) of term infants (p = 0.625 and p = 0.144 respectively). SII was not significantly related to GA, duration of ventilation or FIO2. SIII was positively related to the duration of ventilation (r = 0.729, p < 0.001) and FIO2 (r = 0.704, p < 0.001). Significance: The volumetric capnography phase III slope was steeper in infants with higher ventilatory requirements, hence could potentially be used as an index of disease severity in ventilated newborns.

How does synchronized mechanical ventilation compare with conventional or high-frequency ventilation in newborn infants?

How does synchronized mechanical ventilation compare with conventional or high-frequency ventilation in newborn infants?

Non-invasive high-frequency ventilation in newborn infants with respiratory distress

Non-invasive high-frequency ventilation in newborn infants with respiratory distress

Effect of Humidifier Temperature During Non-invasive Ventilation on Water Condensate and Airway Pressure: Newborn Manikin Model

Recommendation for setting humidifier temperature when using non-invasive ventilation in newborn infants has been changed from low range (32-34 C) to high rang (37 C). However, there is no evidence comparing benefit and hazard between the two settings. To compare the effect of two temperature settings of humidifier during non-invasive ventilation on nasopharyngeal temperature, water condensate and airway pressure. We applied nasal intermittent positive pressure ventilation in a newborn manikin with artificial lungs. The temperature of humidifier was set at high range or low range. We measured nasopharyngeal temperature, water condensate in ventilator circuit and airway pressure in an artificial lung at 0, 8 and 16 hours after starting ventilation. The experiments were conducted 3 times for each setting of humidifier. Comparisons between the groups were analyzed by using Peason’s correlation. Nasopharyngeal temperature with humidifier temperature at high range 34.0 +- 0.1 C was significantly higher than that at low range 32.1 +- 0.2 C (p &lt; 0.001). Volume of water condensate in ventilator circuit was strongly correlated with airway pressure in artificial lungs (r= - 0.828 for PIP, r= -0.948 for PEEP). Water condensate in ventilator circuit significantly decreased airway pressure and interfered with ventilator function. When using non-invasive ventilation, setting humidifier temperature at high range produces substantial water condensate resulting in significantly decreased airway pressure. Therefore, water drainage should be emphasized as an important respiratory care. Funding: Phramongkutklao Foundation

Nasal high frequency oscillatory ventilation in newborn infants: A review of the literature

Nasal high frequency oscillatory ventilation in newborn infants: A review of the literature

Determinants of pulmonary dead space in ventilated newborn infants

BackgroundPulmonary dead space (VD) is an index of ventilation inhomogeneity and one of the determinants of the magnitude of tidal volume to maintain optimal blood gases. AimsTo identify the determinants of VD in ventilated newborns and to investigate differences in VD between prematurely born and term infants and those prematurely born infants who did or did not develop bronchopulmonary dysplasia (BPD). MethodsSixty-one mechanically ventilated infants (15 term, 46 preterm) were studied at a median age of 8 (IQR 2–31) days; 32 of the preterm infants developed BPD. VD was determined from the difference between arterial and end tidal carbon dioxide (CO2) using a low dead space CO2 detector using the Bohr/Enghoff equation and was related to body weight (VD/kg) at the time of study. The time to peak tidal expiratory flow/expiratory time (TPTEF/TE) was measured during spontaneous breathing using a fixed orifice pneumotachograph. ResultsVD/kg was related to gestational age (r=−0.285, p=0.001), birth weight (r=−0.356, p<0.001), weight (r=−0.316, p<0.001) and postmenstrual age (r=−0.205, p=0.020) at measurement, days of ventilation (r=0.322, p<0.001) and TPTEF/TE (r=−0.397, p=0.003). The median VD/kg was higher in prematurely born infants [2.3 (IQR: 1.7–3.0) ml/kg] compared to term infants [1.5 (1.3–2.1) ml/kg, (p=0.003)] and in premature infants that developed BPD [2.6 (IQR 1.8–3.4) ml/kg] compared to those who did not [1.7 (IQR 1.1–1.9) ml/kg], (p<0.001). ConclusionsNumerous factors influence pulmonary dead space and thus an optimum tidal volume will differ according to the underlying demographics and respiratory status.

Mechanical ventilation in newborn infants: Clinical practice guidelines of the Saudi Neonatology Society

Mechanical ventilation is one of the most common therapies in the neonatal intensive care unit (NICU), it is an area where technical complexity overlap individual preferences due to lack of extensive scientific evidence. Our aim is to provide clinical practice guidelines for conventional mechanical ventilation of newborn infants, utilizing the best available scientific evidence and to address the controversies. These guidelines are meant to help the clinician in managing ventilated newborn infants; it should not replace clinical judgment.

High-flow ventilation in newborn infants – what is the evidence?

Abstract Heated Humidified High Flow Nasal Cannula (HHHFNC) devices deliver an adjustable mixture of heated and humidified oxygen and air at a variable flow rate. Over recent years HHHFNC devices have become a popular method of non-invasive respiratory support in infants and preterm neonates due to ease of use and being well tolerated by infants. Recent evidence suggests that HHHFNC therapy may reduce work of breathing and improve the efficiency of ventilation in newborn infants, possibly with clinically significant outcomes such as avoidance of the need for nasal continuous positive airways pressure (nCPAP) and a reduced requirement for invasive ventilation. Despite its rapid adoption, there is relatively limited data about the exact mechanisms of action of HHHFNC. There is growing evidence of the feasibility of HHHFNC as an alternative to other forms of non-invasive ventilation in preterm infants. We review the mechanisms of action, and the supporting evidence in favour of using heated humidified high-flow nasal cannula therapy in newborn infants.

Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in newborn infants.

Mechanical ventilation is a life-saving intervention for critically ill newborn infants with respiratory failure admitted to a neonatal intensive care unit (NICU). Ventilating newborn infants can be challenging due to small tidal volumes, high breathing frequencies, and the use of uncuffed endotracheal tubes. Mechanical ventilation has several short-term, as well as long-term complications. To prevent complications, weaning from the ventilator is started as soon as possible. Weaning aims to support the transfer from full mechanical ventilation support to spontaneous breathing activity. To assess the efficacy of protocolized versus non-protocolized ventilator weaning for newborn infants in reducing the duration of invasive mechanical ventilation, the duration of weaning, and shortening the NICU and hospital length of stay. To determine efficacy in predefined subgroups including: gestational age and birth weight; type of protocol; and type of protocol delivery. To establish whether protocolized weaning is safe and clinically effective in reducing the duration of mechanical ventilation without increasing the risk of adverse events. We searched the Cochrane Central Register of Controlled trials (CENTRAL; the Cochrane Library; 2015, Issue 7); MEDLINE In-Process and other Non-Indexed Citations and OVID MEDLINE (1950 to 31 July 2015); CINAHL (1982 to 31 July 2015); EMBASE (1988 to 31 July 2015); and Web of Science (1990 to 15 July 2015). We did not restrict language of publication. We contacted authors of studies with a subgroup of newborn infants in their study, and experts in the field regarding this subject. In addition, we searched abstracts from conference proceedings, theses, dissertations, and reference lists of all identified studies for further relevant studies. Randomized, quasi-randomized or cluster-randomized controlled trials that compared protocolized with non-protocolized ventilator weaning practices in newborn infants with a gestational age of 24 weeks or more, who were enrolled in the study before the postnatal age of 28 completed days after the expected date of birth. Four authors, in pairs, independently reviewed titles and abstracts identified by electronic searches. We retrieved full-text versions of potentially relevant studies. Our search yielded 1752 records. We removed duplicates (1062) and irrelevant studies (843). We did not find any randomized, quasi-randomized or cluster-randomized controlled trials conducted on weaning from mechanical ventilation in newborn infants. Two randomized controlled trials met the inclusion criteria on type of study and type of intervention, but only included a proportion of newborns. The study authors could not provide data needed for subgroup analysis; we excluded both studies. Based on the results of this review, there is no evidence to support or refute the superiority or inferiority of weaning by protocol over non-protocol weaning on duration of invasive mechanical ventilation in newborn infants.

Non-invasive respiratory support for infants in low- and middle-income countries

The overwhelming majority of neonatal deaths worldwide occur in low- and middle-income countries. Most of these deaths are attributable to respiratory illnesses and complications of preterm birth. The available data suggest that non-invasive continuous positive airway pressure (CPAP) is a safe and cost-effective therapy to reduce neonatal morbidity and mortality in these settings. Bubble CPAP compared to mechanical ventilator-generated CPAP reduces the need for subsequent invasive ventilation in newborn infants. There are limited data on the safety and efficacy of high-flow nasal cannulae in low- and middle-income countries, requiring further study prior to widespread implementation.

PC.24 Transported ventilated newborn infants are at risk of iatrogenic hypocarbia

Background and aimsHypocarbia reduces cerebral blood flow, potentially impairing neurodevelopmental outcome. Avoiding hypocarbia in the ventilated infant during transport can be challenging. Physiology is changing with stabilisation, there are fewer...

P06 Automated control of inspired oxygen in ventilated newborn infants: a randomised crossover study

BackgroundThe risks associated with hyperoxia as well as hypoxia, particularly in the preterm newborn, are well described. Although it is the standard of care for ventilated infants requiring supplemental oxygen...

Study of Pressure Volume Loop in Relation to Radiological Findings among Ventilated Newborn Infants

Introduction: Pulmonary graphics monitoring of lung during mechanical ventilation have shown a reliable data among many ventilated newborn infants. Exposure of the newborn infants and NICU staff to frequent radiation from X-ray chest carries great risk. Aim of work: The aim of this study is to correlate the chest X-ray changes to the pressure –volume loop findings. Subjects and methods: Fifty five ventilated newborn infants due to pulmonary disorders as well as fifteen newborn infants due to non-pulmonary causes were included in this study. They all subjected to medical evaluation and care according to the routine of our unit. The findings from X-ray were collected as well as the pressure volume loop monitoring data at the same time. The data were collected and analyzed using SPPS. Results: There was correlation between pressure volume loop abnormalities and radiological findings of lungs. Newborn infants with RDS whose X ray chest showed a picture of white out lungs had a slit like pattern of P-V loop. Also cases with increase inspiratory resistance and radiological evidence of chronic lung diseases had widening of pulmonary P V loop. The study of pressure volume loop can indicate faulty in air flow when showed a flow starvation pattern. Segmental radiological abnormalities did not correlate with pressure volume loop anomalies. Non pulmonary cases did not show neither abnormal X-ray nor P-V loop abnormalities. Conclusion: Pressure-volume loop provides useful information on the dynamic trends of the respiratory system compliance and resistance. Modern ventilators provide complete monitoring of respiratory system mechanics, which is our guideline for optimizing ventilatory support and avoiding complications associated with mechanical ventilation. Pressure volume loop abnormal changes can correlate significantly with the generalized lung diseases. Several studies are needed to bring more evidence to our results.

Non‐invasively derived respiratory severity score and oxygenation index in ventilated newborn infants

To evaluate the association between the respiratory severity score (RSS) and oxygenation index (OI) in intubated, mechanically ventilated, newborn infants. In a retrospective cohort study (December 2006 to June 2010) medical records of all infants who were admitted to our neonatal intensive care unit (NICU) and required invasive mechanical ventilation were reviewed for patients' demographics, ventilator settings, and arterial blood gas (ABG). During the study period 2,332 infants were admitted to our NICU, and 425 infants were intubated and had an ABG with a gestational age of 30.5 ± 4.9 weeks and a birth weight of 1,635 ± 923 g (mean ± standard deviation). There was a strong association between RSS and OI in infants with oxygen saturation (SaO2 ) between 88% and 94% (R2 = 0.982, n = 101; P < 0.001). In intubated newborn infants, there is a strong association between RSS and OI at SaO2 between 88% and 94%.