scholarly journals Respiratory Care for the Ventilated Neonate

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Gustavo Rocha ◽  
Paulo Soares ◽  
Américo Gonçalves ◽  
Ana Isabel Silva ◽  
Diana Almeida ◽  
...  
Keyword(s):  
Near Infrared ◽  
Periventricular Leukomalacia ◽  
Work Of Breathing ◽  
Newborn Infants ◽  
Pulmonary Hemorrhage ◽  
Added Value ◽  
Respiratory Care ◽  
Pulmonary Mechanics ◽  
Airway Caliber ◽  
Ventilation Modes

Invasive ventilation is often necessary for the treatment of newborn infants with respiratory insufficiency. The neonatal patient has unique physiological characteristics such as small airway caliber, few collateral airways, compliant chest wall, poor airway stability, and low functional residual capacity. Pathologies affecting the newborn’s lung are also different from many others observed later in life. Several different ventilation modes and strategies are available to optimize mechanical ventilation and to prevent ventilator-induced lung injury. Important aspects to be considered in ventilating neonates include the use of correct sized endotracheal tube to minimize airway resistance and work of breathing, positioning of the patient, the nursing care, respiratory kinesiotherapy, sedation and analgesia, and infection prevention, namely, the ventilator-associated pneumonia and nosocomial infection, as well as prevention and treatment of complications such as air leaks and pulmonary hemorrhage. Aspects of ventilation in patients under ECMO (extracorporeal membrane oxygenation) and in palliative care are of increasing interest nowadays. Online pulmonary mechanics and function testing as well as capnography are becoming more commonly used. Echocardiography is now a routine in most neonatal units. Near infrared spectroscopy (NIRS) is an attractive tool potentially helping in preventing intraventricular hemorrhage and periventricular leukomalacia. Lung ultrasound is an emerging tool of diagnosis and can be of added value in helping monitoring the ventilated neonate. The aim of this scientific literature review is to address relevant aspects concerning the respiratory care and monitoring of the invasively ventilated newborn in order to help physicians to optimize the efficacy of care.

The Added Value of Simultaneous EEG and Amplitude-Integrated EEG Recordings in Three Newborn Infants

Neonatology ◽  
2006 ◽  
Vol 91 (3) ◽  
pp. 212-216 ◽  
Author(s):  
Nathalie K.S. de Vries ◽  
Hendrik J. ter Horst ◽  
Arend F. Bos
Keyword(s):  
Newborn Infants ◽  
Added Value ◽  
Eeg Recordings

Human respiratory muscle blood flow measured by near-infrared spectroscopy and indocyanine green

2008 ◽  
Vol 104 (4) ◽  
pp. 1202-1210 ◽  
Author(s):  
Jordan A. Guenette ◽  
Ioannis Vogiatzis ◽  
Spyros Zakynthinos ◽  
Dimitrios Athanasopoulos ◽  
Maria Koskolou ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Infrared Spectroscopy ◽  
Respiratory Muscle ◽  
Near Infrared ◽  
Vastus Lateralis ◽  
Muscle Blood Flow ◽  
Work Of Breathing ◽  
Dilution Method ◽  
Transdiaphragmatic Pressure

Measurement of respiratory muscle blood flow (RMBF) in humans has important implications for understanding patterns of blood flow distribution during exercise in healthy individuals and those with chronic disease. Previous studies examining RMBF in humans have required invasive methods on anesthetized subjects. To assess RMBF in awake subjects, we applied an indicator-dilution method using near-infrared spectroscopy (NIRS) and the light-absorbing tracer indocyanine green dye (ICG). NIRS optodes were placed on the left seventh intercostal space at the apposition of the costal diaphragm and on an inactive control muscle (vastus lateralis). The primary respiratory muscles within view of the NIRS optodes include the internal and external intercostals. Intravenous bolus injection of ICG allowed for cardiac output (by the conventional dye-dilution method with arterial sampling), RMBF, and vastus lateralis blood flow to be quantified simultaneously. Esophageal and gastric pressures were also measured to calculate the work of breathing and transdiaphragmatic pressure. Measurements were obtained in five conscious humans during both resting breathing and three separate 5-min bouts of constant isocapnic hyperpnea at 27.1 ± 3.2, 56.0 ± 6.1, and 75.9 ± 5.7% of maximum minute ventilation as determined on a previous maximal exercise test. RMBF progressively increased (9.9 ± 0.6, 14.8 ± 2.7, 29.9 ± 5.8, and 50.1 ± 12.5 ml·100 ml−1·min−1, respectively) with increasing levels of ventilation while blood flow to the inactive control muscle remained constant (10.4 ± 1.4, 8.7 ± 0.7, 12.9 ± 1.7, and 12.2 ± 1.8 ml·100 ml−1·min−1, respectively). As ventilation rose, RMBF was closely and significantly correlated with 1) cardiac output ( r = 0.994, P = 0.006), 2) the work of breathing ( r = 0.995, P = 0.005), and 3) transdiaphragmatic pressure ( r = 0.998, P = 0.002). These data suggest that the NIRS-ICG technique provides a feasible and sensitive index of RMBF at different levels of ventilation in humans.

Near-Infrared spectroscopy in newborn infants

1992 ◽  
Vol 14 (3) ◽  
pp. 135-143 ◽  
Author(s):  
Kurt von Siebenthal ◽  
Günther Bernert ◽  
Paul Casaer
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Newborn Infants

The Effect of Posture on Ventilation and Lung Mechanics in Preterm and Light-for-Date Infants

PEDIATRICS ◽  
1979 ◽  
Vol 64 (4) ◽  
pp. 429-432 ◽  
Author(s):  
Alastair A. Hutchison ◽  
Keith R. Ross ◽  
George Russell
Keyword(s):  
Tidal Volume ◽  
Prone Position ◽  
Supine Position ◽  
Work Of Breathing ◽  
Newborn Infants ◽  
Lateral Position ◽  
Minute Volume ◽  
Lung Mechanics ◽  
Total Work ◽  
Preterm Group

The effect of right lateral, supine, and prone postures on ventilation and lung mechanics was studied in 23 healthy newborn infants, ten preterm and 13 term, "light-for-date." In the preterm group, tidal volume, minute volume, elastic work, inspiratory viscous work, total viscous work, and the total work of breathing were significantly greater in the prone position than in the supine position. Results obtained in the lateral position did not differ significantly from those in the prone or supine positions. Posture did not significantly affect tidal volume or lung mechanics in the light-for-date infants. The prone position is suggested to be the optimum nursing posture for healthy preterm infants.

Ontogeny of respiratory control and pulmonary mechanics in newborn rabbits

1985 ◽  
Vol 59 (5) ◽  
pp. 1477-1486 ◽  
Author(s):  
M. M. Grunstein ◽  
D. T. Tanaka
Keyword(s):  
Mechanical Properties ◽  
Tidal Volume ◽  
Respiratory System ◽  
Minute Ventilation ◽  
Work Of Breathing ◽  
Relative Volume ◽  
Respiratory Pattern ◽  
Pulmonary Mechanics ◽  
Volume Loss ◽  
Age Related

Maturation of the respiratory pattern and the active and passive mechanical properties of the respiratory system were assessed in 19 tracheotomized rabbits (postnatal age range: 1–26 days) placed in a body plethysmograph. With maturation both minute ventilation and tidal volume significantly increased, whereas respiratory frequency decreased. When normalized for body weight (kg) both the passive (Rrs X kg) and active (R'rs X kg) resistances of the respiratory system significantly increased with age, whereas the corresponding passive (Crs X kg-1) and active (C'rs X kg-1) compliances significantly decreased. At any given age R'rs X kg only slightly exceeded Rrs X kg, whereas C'rs X kg-1 was significantly lower than Crs X kg-1. Moreover, the maturational increases in Rrs X kg and R'rs X kg exceeded the corresponding decreases in Crs X kg-1 and C'rs X kg-1, resulting in significant age-related increases in both the passive (tau rs) and active (tau'rs) time constants of the respiratory system. Due to the age-related increases in tau'rs, producing a delayed volume response to any given inspiratory driving pressure, the relative volume loss obtained at any time during inspiration was greater in the maturing rabbit. On the other hand, because of concomitant compensatory changes in respiratory pattern, evidenced by increases in inspiratory duration with age, the end-inspiratory tidal volume loss in the maturing animal was maintained generally less than 10% at all postnatal ages. Thus maturational changes in respiratory pattern appear coupled to changes in the active mechanical properties of the respiratory system. The latter coupling serves to optimize the transduction of inspiratory pressure into volume change in a manner consistent with establishing the minimum inspiratory work of breathing during postnatal development.

Measurement of Optical Path Length for Cerebral Near-Infrared Spectroscopy in Newborn Infants

1990 ◽  
Vol 12 (2) ◽  
pp. 140-144 ◽  
Author(s):  
J.S. Wyatt ◽  
M. Cope ◽  
D.T. Delpy ◽  
P. van der Zee ◽  
S. Arridge ◽  
...  
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Path Length ◽  
Near Infrared ◽  
Newborn Infants ◽  
Optical Path Length ◽  
Optical Path
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