Advances in respiratory care of the newborn:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa.
Saunders an imprint of Elsevier
2012
|
| Schriftenreihe: | Clinics in perinatology
39,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XVIII S., S. 432 - 752 Ill., graph. Darst. |
| ISBN: | 9781455749201 |
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| adam_text | Titel: Advances in respiratory care of the newborn
Autor: Aschner, Judy L
Jahr: 2012
?Advances in Respiratory Care of the Newborn
Contents
Foreword: Respiratory Care of the Newborn: What Does the Future Hold? xv
Lucky Jain
Preface: Advances in Respiratory Care of the Newborn xvii
Judy L. Aschner and Richard A. Polin
Delivery Room Respiratory Management of the Term and Preterm Infant 431
Tina A. Leone, Neil N. Finer, and Wade Rich
The immediate newborn transition is a time of great physiologic adjust-
ments and many infants need assistance to make a successful transition
to newborn life. Assisted ventilation is the most important intervention per-
formed during this transitional period. Noninvasive ventilation is a necessary
skill for all pediatric providers because it is the most frequently required life-
saving measure provided in the delivery room. Providing ventilation in the
least injurious manner is also necessary and many aspects of how this
can best be done are still unknown. Following the normal physiology of fetal
to neonatal transition continues to be a logical, but challenging, approach to
initial ventilatory support of the newborn in the delivery room.
Effects of Chorioamnionitis on the Fetal Lung 441
Alan H. Jobe
Very preterm infants are commonly exposed to a chronic, often asymp-
tomatic, chorioamnionitis that is diagnosed by histologic evaluation of
the placenta only after delivery. The reported effects of these exposures
on fetal lungs are inconsistent because exposure to different organisms,
durations of exposure, and fetal/maternal responses affect outcomes. In
experimental models, chorioamnionitis can both injure and mature the fetal
lung and cause immune nodulation. Postnatal care strategies also change
how chorioamnionitis relates to clinical outcomes such as bronchopulmo-
nary dysplasia.
Initial Respiratory Support of Preterm Infants: The Role of CPAP, the
INSURE Method, and Noninvasive Ventilation 459
Robert H. Pfister and Roger F. Soil
This article explores the potential benefits and risks for the various ap-
proaches to the initial respiratory management of preterm infants. The au-
thors focus on the evidence for the increasingly used strategies of initial
respiratory support of preterm infants with continuous positive airway pres-
sure (CPAP) beginning in the delivery room or very early in the hospital
course and blended strategies involving the early administration of surfac-
tant replacement followed by immediate extubation and stabilization on
CPAP. Where possible, the evidence referenced in this review comes
from individual randomized controlled trials or meta-analyses of those trials.
?viii Contents
Which Continuous Positive Airway Pressure System is Best for the Preterm Infant
with Respiratory Distress Syndrome? 483
J. Jane Pillow
Various commercial and home-made continuous positive airway pressure
(CPAP) systems are described in this article. CPAP may be delivered via
a range of device-patient interfaces; nasal CPAP is most common, and
short binasal prongs impose the least extrinsic load impedance on the in-
fant. The source of pressure generation is categorized as either constant
pressure or constant flow. The efficacy of different systems may vary ac-
cording to whether lung volume recruitment, airway patency, minimization
of work of breathing, or central nervous system stimulation are the primary
goal of the clinical decision to use CPAP therapy.
Noninvasive Respiratory Support in the Preterm Infant 497
Vineet Bhandari
Multiple randomized controlled trials have suggested that nasal intermit-
tent positive pressure ventilation, compared with nasal continuous airway
pressure, prevents extubation failure and may decrease bronchopulmo-
nary dysplasia. This article summarizes these studies and suggests strat-
egies for the use of nasal intermittent positive pressure ventilation in
neonates.
Volume-Limited and Volume-Targeted Ventilation 513
Colin J. Morley
This article shows that volume-targeted ventilation is physiologically more
logical than pressure-limited ventilation, and is associated with a reduced
risk of pneumothorax, hypocarbia, duration of ventilation, death or bron-
chopulmonary dysplasia, and severe intraventricular hemorrhage. There-
fore, it should now be adopted as the main mode for mechanical
ventilation of preterm neonates.
Synchronized Mechanical Ventilation Using Electrical Activity of the Diaphragm
in Neonates 525
Howard Stein, Kimberly Firestone, and Peter C. Rimensberger
The electrical activity of the diaphragm (Edi) is measured by a specialized
nasogastric/orogastric tube positioned in the esophagus at the level of the
crural diaphragm. Neurally adjusted ventilatory assist (NAVA) uses the Edi
signal as a neural trigger and intrabreath controller to synchronize me-
chanical ventilatory breaths with the patient s respiratory drive and to pro-
portionally support the patient s respiratory efforts on a breath-by-breath
basis. NAVA improves patient-ventilator interaction and synchrony even
in the presence of large air leaks, and might therefore be an optimal option
for noninvasive ventilation in neonates.
Weaning Infants from Mechanical Ventilation 543
G.M. Sant Anna and Martin Keszler
Protracted mechanical ventilation is associated with increased morbidity
and mortality in preterm infants and thus the earliest possible weaning
?Contents
from mechanical ventilation is desirable. Weaning protocols may be help-
ful in achieving more rapid reduction in support. There is no clear consen-
sus regarding the level of support at which an infant is ready for extubation.
An improved ability to predict when a preterm infant has a high likelihood of
successful extubation is highly desirable. In this article, available evidence
is reviewed and reasonable evidence-based recommendations for expedi-
tious weaning and extubation are provided.
Control of Oxygenation During Mechanical Ventilation in the Premature Infant 563
Eduardo Bancalari and Nelson Claure
Maintenance of oxygen saturation targets is a demanding and tedious task
because of the frequency with which oxygenation changes, especially in
small infants receiving prolonged respiratory support. It is clear that the
achievement of oxygenation targets can be improved by a higher nurse-
to-patient ratio and by intense staff training. Automated control systems
can also improve target maintenance, and this is achieved mainly by re-
ducing exposure to hyperoxemia. The long-term benefits and safety of
this strategy are yet to be determined in clinical trials.
Noninvasive Monitoring by Photoplethysmography 573
Rakesh Sahni
The photoplethysmogram (PPG) is a noninvasive circulatory signal related
to the pulsatile volume in tissue and is displayed by many pulse oximeters.
The PPG is similar in appearance to the invasive arterial waveform, but is
noninvasive and ubiquitous in hospitals. There is increasing interest in
seeking circulatory information from the PPG and developing techniques
for a wide variety of novel applications. This article addresses the basic
physics of photoplethysmography, physiologic principles behind pulse
oximetry operation, and recent technological advances in the usefulness
of the PPG waveform to assess microcirculation and intravascular fluid
volume monitoring during intensive care.
Predictors of Bronchopulmonary Dysplasia 585
Andrea Trembath and Matthew M. Laughon
Although significant advances in respiratory care have been made in neo-
natal medicine, bronchopulmonary dysplasia (BPD) remains the most
common serious pulmonary morbidity in premature infants. The develop-
ment of BPD is the result of the complex interactions between multiple
perinatal and postnatal factors. Early identification of infants at the most
risk of developing BPD through the use of estimators and models may
allow a targeted approach at reducing BPD in the future.
Clinical Effectiveness and Safety of Permissive Hypercapnia 603
Julie Ryu, Gabriel Haddad, and Waldemar A. Carlo
Experimental and clinical data indicate that ventilator strategies with per-
missive hypercapnia may reduce lung injury by a variety of mechanisms.
Seven randomized controlled trials in preterm neonates suggest that per-
missive hypercapnia started early, before the initiation of mechanical
?Contents
ventilation (in conjunction with continuous positive airway pressure), fol-
lowed by prolonged permissive hypercapnia if mechanical ventilation is
needed is an alternative to early ventilation and surfactant. Permissive
hypercapnia may improve pulmonary outcomes and survival.
Can Nitric Oxide-Based Therapy Prevent Bronchopulmonary Dysplasia?
Thomas M. Raffay, Richard J. Martin, and James D. Reynolds
A growing understanding of endogenous nitric oxide (NO) biology is help-
ing to explain how and when exogenous NO may confer benefit or harm;
this knowledge is also helping to identify new better-targeted NO-based
therapies. In this review, results of the bronchopulmonary dysplasia clini-
cal trials that used inhaled NO in the preterm population are placed in con-
text, the biologic basis for novel NO therapeutics is considered, and
possible future directions for NO-focused clinical and basic research in
developmental lung disease are identified.
Pathophysiology of Aerodigestive Pulmonary Disorders in the Neonate
Sudarshan R. Jadcherla
No test can provide a definitive diagnosis of aerodigestive disease. When
interpreting tests, one should weigh the benefits and weaknesses of differ-
ent technologies and methods, scientific appropriateness of the testing
conditions, clinicopathologic correlation, and pharmacologic approaches.
Gastroesophageal reflux disease (GERD) symptoms and airway symp-
toms can coexist, and they cannot be distinguished without specific test-
ing and direct observations. Important aerodigestive disorders include
dysphagia, GERD, and aggravation of airway injury due to malfunctions
of swallowing or airway protection mechanisms. Objective evaluation of
aerodigestive reflexes and symptom correlation may provide support for
evidence-based personalized management of feeding and airway protec-
tion strategies.
The Pulmonary Circulation in Neonatal Respiratory Failure
Satyan Lakshminrusimha
The pulmonary circulation rapidly adapts at birth to establish lungs as the
site of gas exchange. Abnormal transition at birth and/or parenchymal lung
disease can result in neonatal hypoxemic respiratory failure. This article re-
views the functional changes in pulmonary hemodynamics and structural
changes in pulmonary vasculature secondary to (1) normal and abnormal
transition at birth, and (2) diseases associated with neonatal hypoxemic
respiratory failure. Various management strategies to correct respiratory
failure are also discussed.
Novel Methods for Assessment of Right Heart Structure and Function in Pulmonary
Hypertension
Gautam K. Singh, Philip T. Levy, Mark R. Holland, and Aaron Hamvas
Long-term increases in pulmonary vascular resistance and pulmonary ar-
terial pressure resulting from structural alterations and abnormal vaso-
reactivity of the pulmonary vasculature may lead to right ventricular (RV)
?Contents xi
remodeling. Conventional methods of assessment of RV structure and
function do not provide sensitive markers of RV remodeling for prognostic
information. Advances in cardiac imaging have provided the capability to
obtain quantitative information on the RV structure and function. This arti-
cle reviews the clinical conditions that result in PH and discusses the novel
and emerging methods for the assessment of right heart structure and
function in PH in infants and children.
Cell-Based Strategies to Reconstitute Lung Function in Infants with Severe
Bronchopulmonary Dysplasia 703
Megan O Reilly and Bernard Thébaud
Recent advances in our understanding of stem/progenitor cells and their
potential to repair damaged organs offer the possibility of cell-based treat-
ments for neonatal lung injury. This review summarizes basic concepts of
stem/progenitor cell biology and discusses the recent advances and chal-
lenges of cell-based therapies for lung diseases, with a particular focus on
bronchopulmonary dysplasia (BPD), a form of chronic lung disease that
primarily affects very preterm infants. Despite advances in perinatal
care, BPD still remains the most common complication of extreme prema-
turity, and there is no specific treatment.
Brain Injury in Chronically Ventilated Preterm Neonates: Collateral Damage
Related to Ventilation Strategy 727
Kurt H. Albertine
Brain injury is a frequent comorbidity in chronically ventilated preterm in-
fants. However, the molecular basis of the brain injury remains incom-
pletely understood. This article discusses the subtle (diffuse) form of
brain injury that has white matter and gray matter lesions without germinal
matrix hemorrhage-intraventricular hemorrhage, posthemorrhagic hydro-
cephalus, or cystic periventricular leukomalacia. This article synthesizes
data that suggest that diffuse lesions to white matter and gray matter
are collateral damage related to ventilator strategy. Evidence is introduced
from the 2 large-animal, physiologic models of evolving neonatal chronic
lung disease that suggest that an epigenetic mechanism may underlie
the collateral damage.
Index
741
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| title | Advances in respiratory care of the newborn |
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| title_exact_search | Advances in respiratory care of the newborn |
| title_full | Advances in respiratory care of the newborn guest ed.: Judy L. Aschner ... |
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