Minimizing Lung Damage During Respiratory Support
|
|
- Ross Lewis
- 5 years ago
- Views:
Transcription
1 Minimizing Lung Damage During Respiratory Support University of Miami Jackson Memorial Medical Center Care of the Sick Newborn 15 Eduardo Bancalari MD University of Miami Miller School of Medicine Jackson Memorial Hospital % Bronchopulmonary Dysplasia (O 2 at 36 wks PMA) Years NICHD NETWORK Gestational Age (wks) What Can Damage The Immature Lung Over distension Excessive V T : PIP PEEP Excessive FRC: PEEP, gas trapping Prolonged inspiratory time Low volume, loss of FRC: Insufficient PEEP Oxidative damage Infection: Pulmonary, systemic Increased PBF-PE : PDA, excessive fluid administration Inadequate conditioning of the inspired gas: Temperature, humidity How Can We Protect The Immature Lung? Accelerate Maturation: Antenatal steroids Surfactant Replacement Prophylaxis vs Rescue? Gentle Ventilation Appropriate tidal volume / Volume target/ HFV Adequate PEEP Patient Triggered Ventilation Permissive hypercapnia? Avoid High Inspired Oxygen Concentrations Avoid Invasive Ventilation: CPAP, N-IPPV Respiratory support strategies to prevent BPD Respiratory support during resuscitation : Ventilation, Oxygen NCPAP vs intubation after birth NIPPV vs IPPV in RDS Synchronized ventilation Permissive hypercapnia HFV: HFO, HFJV Volume targeting Oxygen targets 1
2 % Infants in respiratory care groups Does variation in respiratory management in NICUs explain differences in CLD? Van Marter. Pediatrics, 15, Do differences in delivery room intubation explain different rates of BPD between hospitals? Compared Columbia NY with 2 Boston hospitals. Infants < 151g in Boston Columbia n=341 n=1 Ventilation 75% 29% Surfactant 45% 1% Oxygen at 36 wks 22% 4% IPPV >24h = OR for BPD 2.4 IPPV >7d = OR for BPD 14.9 Gagliardi, L et al. Arch Child Fetal Neonatal Ed. 11;96:F3-F35 NCPAP vs. IPPV BPD or Death Early CPAP vs. IPPV in extremely low gestational age newborns Death/BPD IPPV Surfactant CPAP MV-Surf CPAP MV-Surf CPAP MV-Surf COIN wks 34% 39% 58.7% 1% 38% 77% SUPPORT wks 49% 54% 83.1% 24.8 d 99.7% 27.7d 67% 99% VON (CPAP) 26-3 wks 31% 37% 52% 96% 46% 99% VON (ISX) 29% 37% 59% 96% 98% 99% Fischer S H, and Buhrer C, Pediatrics Nov Distribution of infants (%) into respiratory care groups by birth weights CPAP-started (% of total) CPAP-success (% of CPAP-started) CPAP-success (% of total) Is Nasal Ventilation a Better Alternative? <125 Possible mechanisms of action: Increase in Vt and Ve Upper airway stimulation may reduce apnea Higher mean airway pressure: Better lung stability and gas exchange Reduced dead space: Clears exhaled gas from proximal airway Birth weight (g) Adapted from Ammari et al. J Pediatr. 5; 147(3):
3 Ventilator Dependence Nasal Ventilation Physiologic effects Decreases apnea Improves ventilation- gas exchange Increases lung volume- improves oxygenation Decreases respiratory effort Decreases chest wall distortion Non Invasive Respiratory Support - Conclusions Many very premature infants can be managed with NCPAP or NIPPV from birth It is difficult to predict which infants will fail and require intubation and mechanical ventilation Success depends on gestational age, degree of lung disease, respiratory drive, and team s attitude and skills Use of NIPPV instead of CPAP may reduce the number of infants that need intubation and shortens the duration of MV Early NCPAP or NIPPV may delay administration of surfactant in infants with RDS and worsen their evolution The evidence that non invasive respiratory support improves short or long term outcome in ELBW infants is not very compeling Approach to VLBWI in the DR Depressed - Poor resp effort ET tube IPPV Surfactant if RDS When stable extubate to NCPAP or N-IMV Deterioration, Increasing FiO2, PaCO2, Apnea ET tube-ippv- Surfactant if RDS When stable extubate to NCPAP or N-IMV Active - Good resp effort Start NCPAP or N-IMV Stable-Continue NCPAP Newer Modalities of Mechanical Ventilation Patient Triggered (Synchronized Ventilation) S-IMV Assist control Pressure support Proportional assist ventilation (PAV) NAVA (Neurally adjusted ventilatory assist) Volume targeted ventilation Experimental: Closed Loop FiO 2 control Continuous flow or distal tracheal ventilation Targeted minute ventilation CONTROLLED IPPV (Apnea or M. Relaxants) ASSISTED VENTILATION IMV - SIMV - AC - PSV - PAV Synchronized vs. Conventional Ventilation Duration of ventilation NON INVASIVE SUPPORT Nasal CPAP - Nasal IPPV Greenough and Dimitriou Cochrane Database 8 3
4 IMV vs. SIMV and Hypoxemia in Preterm Infants cmh 2O SIMV ( b/m) P aw 16 ml V T cmh 2O.8 s SIMV (1 b/m) + PS P aw 16 ml V T Firme SRE et al. Pediatr Pulmonol 5;(1):9-14 Time to extubation 1 SIMV+PS SIMV Ventilator and Oxygen Dependency 7-1g BW strata SIMV SIMV+PS Ventilator Dependency (%) 8 6 On MV at day 28 SIMV 69% SIMV+PS 47% Days on MV (median, 25 th and 75 th percentile) Days on oxygen (median, 25 th and 75 th percentile) 25 (8-47) 15 (6-23) 58 (44-87) 41 (34-51)* Time (Days) Reyes et al. Pediatrics October 6 On oxygen at 36w PMA Reyes et al. Pediatrics October % *P.34 Pressure Support Ventilation Patient maintains spontaneous respiratory effort Duration of inspiration and expiration determined by the patient Spontaneous breaths can be unloaded as necessary to maintain Vt and Ve Volume loss can be prevented by few larger SIMV breaths Weaning is accomplished by gradual reduction of the pressure support Limitations of PTV Low Sensitivity of trigger Lack of trigger Trigger delay: Mechanical breath extending into expiration causing active expiration Excessive sensitivity to trigger artifacts: Auto triggering Early termination, mechanical inspiration too short: insufficient tidal volume Added dead space:co2 retention 4
5 Volume Targeted Ventilation Volume-targeted vs. pressure limited ventilation: Duration of IPPV VTV versus PLV: Death or BPD (36 weeks) Duration of IPPV (log data) No. of studies No. of Infants Statistical method Mean Difference (IV, Fixed, 95% CI) Effect size -.8 [-.16, -.] Wheeler K et al. Cochrane Database of Systematic Reviews 1, Issue 11. Significant difference Death or BPD 32% v 43% RR.73 95% CI.57 to.93, NNT 8 Wheeler K et al Neonatology 11 VTV versus PLV: Pneumothorax VTV versus PLV: Grade 3/4 IVH or PVL Pneumothorax Significant 4% difference v 1% RR.46, 95% CI Wheeler K et al Neonatology 11 PVL or grade 3-4 IVH 8% v 16% RR.48, 95% Significant CI.28 - difference.84 Wheeler K et al Neonatology 11 5
6 Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis BPD VG Peng WS et al. Arch Dis Child Fetal Neonatal Ed 13;:F1 F8. doi:1.1136/archdischild Volume targeted ventilation Rationale: More consistent Vt avoids excessive volumes Automatic weaning of pressure Shorter duration of mechanical ventilation Reduces duration of hypoxemia episodes Reduces death or BPD Limitations: Leaks around the endotracheal tube Poor estimation of Vt: Different inspiratory and expiratory Vt with leaks Volume loss in the ventilator circuit: Vt delivered by ventilator larger than patient Vt Cools F, Henderson-Smart DJ. Cochrane Database of Systematic Reviews 9 Hyperoxia Disrupts Alveolar Development Room air O 2 OXYGEN DAMAGE Contrasting light microphotographs of lung parenchyma of rats exposed to room air and O 2 Shaffer SG, et al. Pediatr Res. 1987;21:14-. 6
7 Incidence (%) TEN YEAR TRENDS IN NEONATAL ASSISTED VENTILATION Are New Ventilation Modalities Associated With Better Outcome? Rich W, et al: Journal of Perinatology 3, 23:66 Unadjusted annual rates for GA <29 weeks (n = 1441) 39 th Annual International Conference BPD Severe BPD Miami Neonatology 15 & Workshop: Advances in Neonatal Respiratory Care November 11 November 14, 15 Fontainebleau, Miami Beach Year Smith et al. J Pediatr. April 5; 146(4): Speakers Topics Thrombocytopenia in the NICU Robert Bob Christensen, MD Evidence-based NICU transfusion guidelines Growing extremely premature infants in the NICU Scott C. Denne, MD Providing enteral nutrition to extremely premature Terrie Eleanor Inder, MD, M.B.CH.B. Influence of the environment and experience on brain development To MRI or not to MRI at term for the preterm infant Julie R. Ingelfinger, MD Acute kidney injury (AKI) in the neonatal period Shahab Noori, MD, RDCS The neonate with CAKUT Diagnosis and Management of Neonatal Hypotension and Shock Saroj Saigal, MD, FRCP Pathophysiology of P/IVH in the very preterm neonate Pablo Sanchez, MD Lifetime perspectives of former very premature infants Quality of life of former premature infants Umberto Simeoni, MD Antimicrobial Stewardship in NICU Sergio Stagno, MD Early nutrition and the risk for long term disease Extreme preterm birth and medical decision making Anton H van Kaam, MD, PhD Perinatal viral infections, new developments on an old challenge Myra Wyckoff, MD High frequency ventilation Lung protective ventilation using conventional modes Jill L. Maron, MD, MPH 15 New Neonatal Resuscitation Guidelines Use of monitoring and Epinephrine in the DR 7
Dr. AM MAALIM KPA 2018
Dr. AM MAALIM KPA 2018 Journey Towards Lung protection Goals of lung protection Strategies Summary Conclusion Before 1960: Oxygen; impact assessed clinically. The 1960s:President JFK, Ventilators mortality;
More informationKugelman A, Riskin A, Said W, Shoris I, Mor F, Bader D.
Heated, Humidified High-Flow Nasal Cannula (HHHFNC) vs. Nasal Intermittent Positive Pressure Ventilation (NIPPV) for the Primary Treatment of RDS, A Randomized, Controlled, Prospective, Pilot Study Kugelman
More informationNon Invasive Ventilation In Preterm Infants. Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid
Non Invasive Ventilation In Preterm Infants Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid Summary Noninvasive ventilation begings in the delivery room
More informationVon Reuss and CPAP, Disclosures CPAP. Noninvasive respiratory therapieswhy bother? Noninvasive respiratory therapies- types
Noninvasive respiratory therapiesby a nose? NEO- The Conference for Neonatology February 21, 2014 Disclosures I have no relevant financial relationships to disclose or conflicts of interest to release.
More informationHyaline membrane disease. By : Dr. Ch Sarishma Peadiatric Pg
Hyaline membrane disease By : Dr. Ch Sarishma Peadiatric Pg Also called Respiratory distress syndrome. It occurs primarily in premature infants; its incidence is inversely related to gestational age and
More informationLung Wit and Wisdom. Understanding Oxygenation and Ventilation in the Neonate. Jennifer Habert, BHS-RT, RRT-NPS, C-NPT Willow Creek Women s Hospital
Lung Wit and Wisdom Understanding Oxygenation and Ventilation in the Neonate Jennifer Habert, BHS-RT, RRT-NPS, C-NPT Willow Creek Women s Hospital Objectives To review acid base balance and ABG interpretation
More informationObjectives. Apnea Definition and Pitfalls. Pathophysiology of Apnea. Apnea of Prematurity and hypoxemia episodes 5/18/2015
Apnea of Prematurity and hypoxemia episodes Deepak Jain MD Care of Sick Newborn Conference May 2015 Objectives Differentiating between apnea and hypoxemia episodes. Pathophysiology Diagnosis of apnea and
More informationNeonatal Resuscitation Using a Nasal Cannula: A Single-Center Experience
Original Article Neonatal Resuscitation Using a Nasal Cannula: A Single-Center Experience Pedro Paz, MD, MPH 1 Rangasamy Ramanathan, MD 1,2 Richard Hernandez, RCP 2 Manoj Biniwale, MD 1 1 Division of Neonatal
More informationNAVA. In Neonates. Howard Stein, M.D. Director Neonatology. Neurally Adjusted Ventilatory Assist. Toledo Children s Hospital Toledo, Ohio
NAVA Neurally Adjusted Ventilatory Assist In Neonates Howard Stein, M.D. Director Neonatology Toledo Children s Hospital Toledo, Ohio Disclaimers Dr Stein: Is discussing products made by Maquet Has no
More informationQuality Improvement Approaches to BPD. Jay P. Goldsmith, M.D. Tulane University New Orleans, Louisiana
Quality Improvement Approaches to BPD Jay P. Goldsmith, M.D. Tulane University New Orleans, Louisiana goldsmith.jay@gmail.com No conflicts of interest to declare There is nothing more dangerous to the
More informationWeaning and extubation in PICU An evidence-based approach
Weaning and extubation in PICU An evidence-based approach Suchada Sritippayawan, MD. Div. Pulmonology & Crit Care Dept. Pediatrics Faculty of Medicine Chulalongkorn University Kanokporn Udomittipong, MD.
More informationPrepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.
More informationName and title of the investigators responsible for conducting the research: Dr Anna Lavizzari, Dr Mariarosa Colnaghi
Protocol title: Heated, Humidified High-Flow Nasal Cannula vs Nasal CPAP for Respiratory Distress Syndrome of Prematurity. Protocol identifying number: Clinical Trials.gov NCT02570217 Name and title of
More informationProvide guidelines for the management of mechanical ventilation in infants <34 weeks gestation.
Page 1 of 5 PURPOSE: Provide guidelines for the management of mechanical ventilation in infants
More informationPotential Conflicts of Interest
Potential Conflicts of Interest Patient Ventilator Synchrony, PAV and NAVA! Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 4-27-09 WSRC Received research
More informationUsefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome
European Review for Medical and Pharmacological Sciences 2015; 19: 573-577 Usefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome B.
More informationNEONATAL NEWS Here s Some More Good Poop
NEONATALNEWS Here ssomemoregoodpoop WINTEREDITION2010 THISNEWSLETTERISPUBLISHEDPERIODICALLYBYTHENEONATOLOGISTSOF ASSOCIATESINNEWBORNMEDICINETOCONVEYNEWANDUPDATEDPOLICIES ANDGUIDELINESANDPROVIDEGENERALEDUCATIONTONICUCARETAKERSAT
More informationOriginal Article. Effects of Pressure Support during an Acute Reduction of Synchronized Intermittent Mandatory Ventilation in Preterm Infants
Original Article Effects of Pressure Support during an Acute Reduction of Synchronized Intermittent Mandatory Ventilation in Preterm Infants Waldo Osorio, MD Nelson Claure, PhD Carmen D Ugard, RRT Kamlesh
More informationGE Healthcare. Non Invasive Ventilation (NIV) For the Engström Ventilator. Relief, Relax, Recovery
GE Healthcare Non Invasive Ventilation (NIV) For the Engström Ventilator Relief, Relax, Recovery COPD is currently the fourth leading cause of death in the world, and further increases in the prevalence
More informationDisclosure COULD AUTOMATED CONTROL OF OXYGEN LEVELS IMPROVE SURVIVAL AND REDUCE NEC? Oxygen Dependency
COULD AUTOMATED CONTROL OF OXYGEN LEVELS IMPROVE SURVIVAL AND REDUCE NEC? Eduardo Bancalari MD University of Miami Miller School of Medicine Jackson Memorial Medical Center Sydney 206 Disclosure The University
More informationThis is a pre-copyedited, author-produced PDF of an article accepted for publication in Journal of Neonatal Nursing following peer review.
This is a pre-copyedited, author-produced PDF of an article accepted for publication in Journal of Neonatal Nursing following peer review. The version of record [Journal of Neonatal Nursing (February 2013)
More informationSurfactant Administration
Approved by: Surfactant Administration Gail Cameron Senior Director Operations, Maternal, Neonatal & Child Health Programs Dr. Paul Byrne Medical Director, Neonatology Neonatal Policy & Procedures Manual
More informationAn Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy
An Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy Housekeeping: I have no financial disclosures Learning objectives: Develop an understanding of bronchopulmonary dysplasia (BPD)
More informationYou are caring for a patient who is intubated and. pressure control ventilation. The ventilator. up to see these scalars
Test yourself Test yourself #1 You are caring for a patient who is intubated and ventilated on pressure control ventilation. The ventilator alarms and you look up to see these scalars What is the most
More informationBreathing: Conventional. Matter?
Breathing: Conventional Ventilation Does the Mode Matter? Brian K. Walsh, RRT NPS, FAARC Director of Respiratory Care Children s Medical Center Dallas Disclosure Research relationships: Maquet NAVA GE
More informationNoah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018
Postnatal Steroids Use for Bronchopulmonary Dysplasia in 2018 + = Noah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018 AAP Policy Statement - 2002 This statement is intended for
More informationMechanical Ventilation Principles and Practices
Mechanical Ventilation Principles and Practices Dr LAU Chun Wing Arthur Department of Intensive Care Pamela Youde Nethersole Eastern Hospital 6 October 2009 In this lecture, you will learn Major concepts
More informationAim: Reduction in the rate of CLD in ELBW infants (<1000 grams) by 30% from its baseline of 72 % by January 2016.
LIVE (Less Invasive Ventilation of ELBW infants) HEALTHY WVU Children s Hospital, Morgantown, WV, USA Rebecca Tilley, RN; Jamie Karr, RT; Tiffany Blosser, RN; Christy Dixon, RT; Melinda Connolly, ANP;
More informationAEROSURF Phase 2 Program Update Investor Conference Call
AEROSURF Phase 2 Program Update Investor Conference Call November 12, 2015 Forward Looking Statement To the extent that statements in this presentation are not strictly historical, including statements
More informationTO THE OPERATOR AND PERSON IN CHARGE OF MAINTENANCE AND CARE OF THE UNIT:
fabian HFO Quick guide TO THE OPERATOR AND PERSON IN CHARGE OF MAINTENANCE AND CARE OF THE UNIT: This Quick Guide is not a substitute for the Operation Manual. Read the Operation Manual carefully before
More informationNAVA-korzyści dla noworodka
DISCLOSURE No conflict of interest related to this topic NAVA-korzyści dla noworodka Jan Mazela Poznan University of Medical Sciences Poznan, Poland EUROPE POZNAŃ and WIELKOPOLSKA REGION POLAND WIELKOPOLSKA
More informationVolume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study
D-32084-2011 Volume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study Robert DiBlasi RRT-NPS, FAARC Respiratory Care Manager of Research & Quality
More informationRespiratory Management and Outcome of Preterm Infants
Respiratory Management and Outcome of Preterm Infants 6 th Annual Care Of The Sick Newborn Conference Shu Wu, MD. Department of Pediatrics Division of Neonatology University of Miami School of Medicine
More informationKing s Research Portal
King s Research Portal DOI: 10.1007/s00431-015-2595-4 Document Version Peer reviewed version Link to publication record in King's Research Portal Citation for published version (APA): Shetty, S., Bhat,
More informationSaturation Targets Are They Achievable? Preventing Intermittent Hypoxemia
Saturation Targets Are They Achievable? Preventing Intermittent Hypoxemia Professor and Chief Department of Neonatology Tuebingen University Hospital Prof. Poets graduated from Hannover Medical School
More informationCONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Method of maintaining low pressure distension of lungs during inspiration and expiration when infant breathing spontaneously Benefits Improves oxygenation
More informationSTOP ROP The STOP-ROP Multicenter Study Group: Pediatrics 105:295, 2000 Progression to Threshold Conventional Sat 89-94% STOP ROP
Hrs TcPO2 > 80 nnhg (weeks 1 4) OXYGEN TARGETS: HOW GOOD ARE WE IN ACHIEVING THEM Oxygen Dependency GA wks Eduardo Bancalari MD University of Miami Miller School of Medicine Jackson Memorial Medical Center
More informationNasal respiratory Support: The best Option for Resource Restricted (and Rich) Countries?
Nasal respiratory Support: The best Option for Resource Restricted (and Rich) Countries? Rangasamy Ramanathan, MD. Professor of Pediatrics Division Chief, Division of Neonatology Program Director, NPM
More information9/15/2017. Disclosures. Heated High Flow Nasal Cannula: Hot Air or Optimal Noninvasive Support? Objectives. Aerogen Pharma
Heated High Flow Nasal Cannula: Hot Air or Optimal Noninvasive Support? Rob DiBlasi RRT-NPS, FAARC Program Manager Research/QI, Respiratory Therapy Principle Investigator, Seattle Children s Research Institute
More informationNasal CPAP in Neonatology: We Can Do Better
Nasal CPAP in Neonatology: We Can Do Better COI Disclosure I do not have any conflict of interest, nor will I be discussing any off-label product use. This class has no commercial support or sponsorship,
More informationCOMPARISON OF THE EFFICIENCY OF CAFFEINE VERSUS AMINOPHYLLINE FOR THE TREATMENT OF APNOEA OF PREMATURITY
CASE STUDIES COMPARISON OF THE EFFICIENCY OF CAFFEINE VERSUS AMINOPHYLLINE FOR THE TREATMENT OF APNOEA OF PREMATURITY Gabriela Ildiko Zonda 1, Andreea Avasiloaiei 1, Mihaela Moscalu 2, Maria Stamatin 1
More informationMechanical Ventilation 1. Shari McKeown, RRT Respiratory Services - VGH
Mechanical Ventilation 1 Shari McKeown, RRT Respiratory Services - VGH Objectives Describe indications for mcvent Describe types of breaths and modes of ventilation Describe compliance and resistance and
More information** SURFACTANT THERAPY**
** SURFACTANT THERAPY** Full Title of Guideline: Surfactant Therapy Author (include email and role): Stephen Wardle (V4) Reviewed by Dushyant Batra Consultant Neonatologist Division & Speciality: Division:
More informationYorkshire & Humber Neonatal ODN (South) Clinical Guideline
Yorkshire & Humber Neonatal ODN (South) Clinical Guideline Title: Ventilation Author: Dr Cath Smith updated September 2017, written by Dr Elizabeth Pilling May 2011 Date written: May 2011 Review date:
More informationDr. Yasser Fathi M.B.B.S, M.Sc, M.D. Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah
BY Dr. Yasser Fathi M.B.B.S, M.Sc, M.D Anesthesia Consultant, Head of ICU King Saud Hospital, Unaizah Objectives For Discussion Respiratory Physiology Pulmonary Graphics BIPAP Graphics Trouble Shootings
More informationA multipurpose ventilator. Flow-SNIPPV - a new challenge in neonatal respiratory care
Neonatal Ventilator A multipurpose ventilator Giulia Ventilator is a next-generation ventilator designed to give the best respiratory support at every step of the clinical treatment of the respiratory
More informationDisclosures. Learning Objectives. Mechanical Ventilation of Infants with Severe BPD: An Interdisciplinary Approach 3/10/2017
Mechanical Ventilation of Infants with Severe BPD: An Interdisciplinary Approach Steven H. Abman, MD Professor, Department of Pediatrics Director, Pediatric Heart Lung Center University of Colorado School
More informationKing s Research Portal
King s Research Portal DOI: 10.1007%2Fs00431-015-2595-4 Document Version Peer reviewed version Link to publication record in King's Research Portal Citation for published version (APA): Shetty, S., Bhat,
More informationNewborn Life Support. NLS guidance.
Kelly Harvey, ANNP NWNODN, previously Wythenshawe Hospital has shared this presentation with the understanding that it is for personal use following your attendance at the 8th Annual Senior Neonatal Nursing
More informationPATENT DUCTUS ARTERIOSUS IN THE PRETERM INFANT EVIDENCE FOR & AGAINST TREATMENT
PATENT DUCTUS ARTERIOSUS IN THE PRETERM INFANT EVIDENCE FOR & AGAINST TREATMENT Dr. Youssef Abou Zanouna, FRCPI, FACC Consultant Pediatric Cardiologist King Fahd Military Medical Complex Dhahran Introduction
More informationUsing NAVA titration to determine optimal ventilatory support in neonates
The University of Toledo The University of Toledo Digital Repository Master s and Doctoral Projects Using NAVA titration to determine optimal ventilatory support in neonates Stacey Leigh Fisher The University
More informationAPRV Ventilation Mode
APRV Ventilation Mode Airway Pressure Release Ventilation A Type of CPAP Continuous Positive Airway Pressure (CPAP) with an intermittent release phase. Patient cycles between two levels of CPAP higher
More informationWeaning from Mechanical Ventilation. Dr Azmin Huda Abdul Rahim
Weaning from Mechanical Ventilation Dr Azmin Huda Abdul Rahim Content Definition Classification Weaning criteria Weaning methods Criteria for extubation Introduction Weaning comprises 40% of the duration
More informationBubble CPAP for Respiratory Distress Syndrome in Preterm Infants
R E S E A R C H P A P E R Bubble CPAP for Respiratory Distress Syndrome in Preterm Infants JAGDISH KOTI*, SRINIVAS MURKI, PRAMOD GADDAM, ANUPAMA REDDY AND M DASARADHA RAMI REDDY From Fernandez Hospital
More informationEarly Human Development
Early Human Development 88 (2012) 925 929 Contents lists available at SciVerse ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev Developing a neonatal unit ventilation
More informationSTATE OF OKLAHOMA 2014 EMERGENCY MEDICAL SERVICES PROTOCOLS
3K NON-INVASIVE POSITIVE PRESSURE VENTILATION (NIPPV) ADULT EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC Indications: 1. Dyspnea Uncertain Etiology Adult. 2. Dyspnea Asthma Adult. 3. Dyspnea Chronic
More informationCourse no: Course 6 Title: Anaesthesia According to the Patient, Type of Surgery and Mode of Organization Sub-category: Ventilatory Support Topic:
Course no: Course 6 Title: Anaesthesia According to the Patient, Type of Surgery and Mode of Organization Sub-category: Ventilatory Support Topic: Mechanical Ventilation in Infants and Neonates Date: Sep
More informationProportional Assist Ventilation (PAV) (NAVA) Younes ARRD 1992;145:114. Ventilator output :Triggering, Cycling Control of flow, rise time and pressure
Conflict of Interest Disclosure Robert M Kacmarek Unconventional Techniques Using Your ICU Ventilator!" 5-5-17 FOCUS Bob Kacmarek PhD, RRT Massachusetts General Hospital, Harvard Medical School, Boston,
More informationWeaning: The key questions
Weaning from mechanical ventilation Weaning / Extubation failure: Is it a real problem in the PICU? Reported extubation failure rates in PICUs range from 4.1% to 19% Baisch SD, Wheeler WB, Kurachek SC,
More informationCURRENT TRENDS IN NON-INVASIVE VENTILATION. Disclosures. Why not invasive ventilation? Objectives. Currently available modes
CURRENT TRENDS IN NON-INVASIVE VENTILATION ----------------------------------------------------------- Karen Drinkard, RRT-NPS Neonatal Respiratory Clinical Specialist University of Washington Medical
More informationNon-invasive respiratory support for neonates Prof. Dr. med. Charles Christoph Roehr
D-16666-2009 Non-invasive respiratory support for neonates Prof. Dr. med. Charles Christoph Roehr 2 I Important note: Medical knowledge is subject to constant change as a consequence of research and clinical
More informationBest Practices in Bronchopulmonary
Best Practices in Bronchopulmonary Dysplasia a (BPD) Prevention e Matthew M. Laughon, MD, MPH Professor of Pediatrics The University of North Carolina at Chapel Hill I receive support from the U.S. government
More informationInnovations in Neonatal Ventilation
Innovations in Neonatal Ventilation NAVA Neurally Adjusted Ventilatory Assist Howard Stein, M.D. Director Neonatology, Promedica Toledo Children s Hospital Clinical Professor of Pediatrics, University
More informationFaculty Disclosure. Off-Label Product Use
Faculty Disclosure X No, nothing to disclose Yes, please specify: Company Name Honoraria/ Expenses Consulting/ Advisory Board Funded Research Royalties/ Patent Stock Options Equity Position Ownership/
More informationO) or to bi-level NCPAP (group B; n=20, lower CPAP level=4.5 cm H 2
1 NICU, Children s Hospital, Via Castelvetro, Milan, Italy 2 Laboratory, V.Buzzi Children s Hospital ICP, Milan, Italy 3 Department of Statistics, Catholic University, Milan, Italy Correspondence to Gianluca
More informationRecognizing and Correcting Patient-Ventilator Dysynchrony
2019 KRCS Annual State Education Seminar Recognizing and Correcting Patient-Ventilator Dysynchrony Eric Kriner BS,RRT Pulmonary Critical Care Clinical Specialist MedStar Washington Hospital Center Washington,
More informationRandomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome
Acta Pñdiatr 92: 1±6. 2003 Randomized study of nasal continuous positive airway pressure in the preterm infant with respiratory distress syndrome J Tooley and M Dyke Department of Paediatrics, Norfolk
More informationNON-INVASIVE VENTILATION. Lijun Ding 23 Jan 2018
NON-INVASIVE VENTILATION Lijun Ding 23 Jan 2018 Learning objectives What is NIV The difference between CPAP and BiPAP The indication of the use of NIV Complication of NIV application Patient monitoring
More information1. Which of the following arterial blood gas results indicate metabolic acidosis?
B10 Baby s Breath: Ventilation Strategies and Blood Gas Interpretation Mary Beth Bodin, DNP, CRNP, NNP-BC Assistant Professor School of Nursing, University of Alabama at Birmingham Neonatal Nurse Practitioner
More informationLate pulmonary hypertension in preterm infants How to sort things out? V.Gournay, FCPC, La Martinique, Nov 23,2015
Late pulmonary hypertension in preterm infants How to sort things out? V.Gournay, FCPC, La Martinique, Nov 23,2015 Epidemiology Incidence of extreme prematurity (
More informationTest Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo
Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/
More informationResearch Article Factors Affecting the Weaning from Nasal CPAP in Preterm Neonates
International Pediatrics Volume 2012, Article ID 416073, 7 pages doi:10.1155/2012/416073 Research Article Factors Affecting the Weaning from Nasal CPAP in Preterm Neonates Shantanu Rastogi, 1, 2 Hariprem
More information9Synchronized and. Mechanical ventilation has improved to the point. Volume-Targeted Ventilation
Acute Respiratory Care of the Neonate 9Synchronized and Volume-Targeted Ventilation Martin Keszler, MD Mechanical ventilation has improved to the point where few infants now die of acute respiratory failure.
More informationThe Art and Science of Weaning from Mechanical Ventilation
The Art and Science of Weaning from Mechanical Ventilation Shekhar T. Venkataraman M.D. Professor Departments of Critical Care Medicine and Pediatrics University of Pittsburgh School of Medicine Some definitions
More informationCLINICAL VIGNETTE 2016; 2:3
CLINICAL VIGNETTE 2016; 2:3 Editor-in-Chief: Olufemi E. Idowu. Neurological surgery Division, Department of Surgery, LASUCOM/LASUTH, Ikeja, Lagos, Nigeria. Copyright- Frontiers of Ikeja Surgery, 2016;
More information17400 Medina Road, Suite 100 Phone: Minneapolis, MN Fax:
17400 Medina Road, Suite 100 Phone: 763-398-8300 Minneapolis, MN 55447-1341 Fax: 763-398-8400 www.pulmonetic.com Clinical Bulletin To: Cc: From: Domestic Sales Representatives and International Distributors
More informationROLE OF EARLY POSTNATAL DEXAMETHASONE IN RESPIRATORY DISTRESS SYNDROME
INDIAN PEDIATRICS VOLUME 35-FEBRUAKY 1998 ROLE OF EARLY POSTNATAL DEXAMETHASONE IN RESPIRATORY DISTRESS SYNDROME Kanya Mukhopadhyay, Praveen Kumar and Anil Narang From the Division of Neonatology, Department
More informationCONVENTIONAL VENTILATION Part II
CONVENTIONAL VENTILATION Part II Conventional Ventilation Part II Objective of Presentation Review disease specific ventilator strategies Discuss non-invasive approaches to improving gas exchange Review
More informationI. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP
I. Subject: Pressure Support Ventilation (PSV) with BiPAP Device/Nasal CPAP II. Policy: PSV with BiPAP device/nasal CPAP will be initiated upon a physician's order by Respiratory Therapy personnel trained
More informationB13. Baby s Breath: Ventilation Strategies and Blood Gas Interpretation. Session Summary. Session Objectives. Test Questions.
B13 Baby s Breath: Ventilation Strategies and Blood Gas Interpretation Karen Wright, PhD, NNP-BC DNP NNP Program Director Rush University, Chicago, IL The speaker has signed a disclosure form and indicated
More informationNeonatal Resuscitation in What is new? How did we get here? Steven Ringer MD PhD Harvard Medical School May 25, 2011
Neonatal Resuscitation in 2011- What is new? How did we get here? Steven Ringer MD PhD Harvard Medical School May 25, 2011 Conflicts I have no actual or potential conflict of interest in relation to this
More informationHandling Common Problems & Pitfalls During. Oxygen desaturation in patients receiving mechanical ventilation ACUTE SEVERE RESPIRATORY FAILURE
Handling Common Problems & Pitfalls During ACUTE SEVERE RESPIRATORY FAILURE Pravit Jetanachai, MD QSNICH Oxygen desaturation in patients receiving mechanical ventilation Causes of oxygen desaturation 1.
More informationIs There a Treatment for BPD?
Is There a Treatment for BPD? Amir Kugelman, Pediatric Pulmonary Unit and Department of Neonatology Bnai Zion Medical Center, Rappaport Faculty of Medicine Haifa, Israel Conflict of Interest Our study
More informationWeb Appendix 1: Literature search strategy. BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up. Sources to be searched for the guidelines;
Web Appendix 1: Literature search strategy BTS Acute Hypercapnic Respiratory Failure (AHRF) write-up Sources to be searched for the guidelines; Cochrane Database of Systematic Reviews (CDSR) Database of
More informationEvaluation of the Local Incidence and Determinants of Bronchopulmonary Dysplasia and Pulmonary Morbidity in Extremely Preterm Infants
Evaluation of the Local Incidence and Determinants of Bronchopulmonary Dysplasia and Pulmonary Morbidity in Extremely Preterm Infants by Amber Elise Reichert A thesis submitted in partial fulfilment of
More informationRecent Advances in Respiratory Medicine
Recent Advances in Respiratory Medicine Dr. R KUMAR Pulmonologist Non Invasive Ventilation (NIV) NIV Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive
More informationMechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล
Mechanical Ventilation ศ.พ.ญ.ส ณ ร ตน คงเสร พงศ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล Goal of Mechanical Ventilation Mechanical ventilation is any means in which physical device or machines are
More informationProphylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants(review)
Cochrane Database of Systematic Reviews Prophylactic nasal continuous positive airway pressure for preventing morbidity and mortality in very preterm infants (Review) SubramaniamP,HoJJ,DavisPG Subramaniam
More informationSURFACTANT UPDATE. George Mandy, M.D. Nationwide Children s Hospital The Ohio State University
SURFACTANT UPDATE George Mandy, M.D. Nationwide Children s Hospital The Ohio State University Surfactant Update Objectives History Meta-analysis of surfactant therapy New synthetic surfactant Genetic disorders
More informationWaiting to Inhale Jeopardy
Waiting to Inhale: RDS, BPD, and Assisted Ventilation of the Neonate Steven R. Seidner, M.D. Professor of Pediatrics Chief, Division of Neonatal-Perinatal Medicine Waiting to Inhale Jeopardy RDS Surfactant
More informationQuickLung Breather Patient Settings
The QuickLung Breather is capable of simulating a spontaneously breathing patient in a variety of modes and patterns. In response to customer requests, we have compiled five common respiratory cases below.
More informationBRONCHOPULMONARY DYSPLASIA
BRONCHOPULMONARY DYSPLASIA CHRONIC NEONATAL LUNG DISEASE (CLD) 2 2 nd BERLIN NEONATOLOGY SUMMER SCHOOL September 2014 3 Mt. Scopus 4 Ein Kerem 5 BRONCHOPULMONARY DYSPLASIA 1960: Ventilation of Neonates
More informationFANNP 28TH NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEW OCTOBER 17-21, 2017
Pulse Oximetry in the Delivery Room: Principles and Practice GS2 3 Jonathan P. Mintzer, MD, FAAP Assistant Professor of Pediatrics Stony Brook Children s Hospital, Division of Neonatal-Perinatal Medicine,
More informationSimulation 3: Post-term Baby in Labor and Delivery
Simulation 3: Post-term Baby in Labor and Delivery Opening Scenario (Links to Section 1) You are an evening-shift respiratory therapist in a large hospital with a level III neonatal unit. You are paged
More informationEPNV-Montreux 2018: Preliminary Educational and Scientific Program
EPNV-Montreux 2018: Preliminary Educational and Scientific Program April 25-26, 2018: Pre-Conference Workshops Wednesday (April 25): 09 00 18 00 Thursday (April 26): 08 00 12 00 April 26-28, 2018: Main
More informationComparison of Two Levels of Pressure Support Ventilation on Success of Extubation in Preterm Neonates: A Randomized Clinical Trial
Global Journal of Health Science; Vol. 8, No. 2; 2016 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education Comparison of Two Levels of Pressure Support Ventilation on Success
More informationOriginal Paper. Neonatology 2007;92:1 7 DOI: /
Original Paper Neonatology 7;9:1 7 DOI: 1.1159/9876 Received: April 4, 6 Accepted after revision: September 11, 6 Published online: January, 7 Randomized Crossover Comparison of Proportional Assist Ventilation
More informationNIV use in ED. Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH
NIV use in ED Dr. Khalfan AL Amrani Emergency Resuscitation Symposium 2 nd May 2016 SQUH Outline History & Introduction Overview of NIV application Review of proven uses of NIV History of Ventilation 1940
More informationBPD. Neonatal/Pediatric Cardiopulmonary Care. Disease. Bronchopulmonary Dysplasia. Baby Jane
1 Neonatal/Pediatric Cardiopulmonary Care Disease 2 Bronchopulmonary Dysplasia 3 is a 33-day-old prematurely born girl who weighs 1420 g. At birth, her estimated gestational age was 28 weeks. Her initial
More information