The effectiveness of volume guarantee ventilation in newborns

Background. An important goal of treating respiratory disorders in newborns during the first stage of perinatal care is effective and safe pulmonary ventilation, enabling the administration of surfactant therapy, reducing alveolar dead space, and providing adequate gas exchange. Objective. The aim of this study is to improve the quality of newborns respiratory therapy using double pressure and volume control at the first stage of perinatal care. Materials and methods. The study involved newborns from week 27 to week 42 gestation with respiratory failure requiring invasive pulmonary ventilation. The ventilation mode was evaluated with pressure control and volume guarantee option compared with routine pressure ventilation. For the comparative characteristic of the compared ventilation methods, we used targets, such as the duration of artificial pulmonary ventilation, reduction of FiO2, dynamics of venous blood lactate, peak and average pressure in the respiratory tract, dynamics of lung compliance, and the development of complications. Results and conclusions. Given the heterogeneity of lung damage in newborns, the use of the guaranteed volume option reduced the duration of mechanical ventilation, the development frequency of IVH, and the frequency of surfactant use.

Lactate Level Predicts Mortality in Patients with Upper Gastrointestinal Bleeding

Background and Objectives. The aim of this study was to show whether the level of lactate in venous blood compared with the Glasgow-Blatchford Bleeding Score (GBS), in patients diagnosed with upper gastrointestinal system (UGI) bleeding in the emergency department, will help to predict the need for transfusion and prognosis. Materials and Methods. Patients with UGI bleeding who were admitted to the emergency department were included in the study. The parameters age, gender, referral complaints, comorbidities, lactate levels in venous blood, GBS, endoscopy findings, length of hospital stay, transfusion amount, and outcome of patients were recorded in the data collection form. Results. A total of 139 patients were included in the study. The most common complaints were melena (38.1%) and hematemesis (32.4%). The most frequent endoscopic diagnosis was duodenal ulcer (40.3%). The cutoff value of the venous blood lactate level for the prediction of the need for red blood cell transfusion was 1.58 mmol/L, and the cutoff value for GBS was 9.5. While 124 patients were discharged, 15 patients died. The mean value of venous lactate in survived patients was 2.37 mmol/L and 4.80 in dead patients. This difference was statistically significant (p=0.044). The cutoff value of lactate for the prediction of mortality was 2.32 mmol/L, and the cutoff value for GBS was 13.5. Conclusions. The venous blood lactate value of a patient who was admitted to the emergency department with UGI bleeding might be helpful in predicting the transfusion needs of the patient and predicting the mortality.