| Práctica clínica: ventilación no invasiva en recién nacidos |
Clinical practice : noninvasive respiratory support in newborns.
de Winter JP, de Vries MA, Zimmermann LJ.
Department of Pediatrics, Spaarne Hospital, Hoofddorp, The Netherlands.pdewinter@spaarneziekenhuis.nl
Eur J Pediatr. 2010 Jul;169(7):777-82. Epub 2010 Feb 24.
Abstract
The most important goal of introducing noninvasive ventilation (NIV) has been to decrease the need for intubation and, therefore, mechanical ventilation in newborns. As a result, this technique may reduce the incidence of bronchopulmonary dysplasia (BPD). In addition to nasal CPAP, improvements in sensors and flow delivery systems have resulted in the introduction of a variety of other types of NIV. For the optimal application of these novelties, a thorough physiological knowledge of mechanics of the respiratory system is necessary. In this overview, the modern insights of noninvasive respiratory therapy in newborns are discussed. These aspects include respiratory support in the delivery room; conventional and modern nCPAP; humidified, heated, and high-flow nasal cannula ventilation; and nasal intermittent positive pressure ventilation. Finally, an algorithm is presented describing common practice in taking care of respiratory distress in prematurely born infantshttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876262/pdf/431_2010_Article_1159.pdf
|
| Presión positiva continua no invasiva en falla respiratoria aguda: Casco versus mascarilla facial |
Noninvasive continuous positive airway pressure in acute respiratory failure: helmet versus facial mask.
Chidini G, Calderini E, Cesana BM, Gandini C, Prandi E, Pelosi P.
Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. giovannachid@libero.it
Pediatrics. 2010 Aug;126(2):e330-6. Epub 2010 Jul 26.
Abstract
OBJECTIVE:
Noninvasive continuous positive airway pressure (nCPAP) is applied through different interfaces to treat mild acute respiratory failure (ARF) in infants. Recently a new pediatric helmet was introduced in clinical practice to deliver nCPAP. The objective of this study was to compare the feasibility of the delivery of nCPAP by the pediatric helmet with delivery by a conventional facial mask in infants with ARF. PATIENTS AND METHODS: We conducted a single-center physiologic, randomized, controlled study with a crossover design on 20 consecutive infants with ARF. All patients received nCPAP by helmet and facial mask in random order for 90 minutes. In infants in both trials, nCPAP treatment was preceded by periods of unassisted spontaneous breathing through a Venturi mask. The primary end point was the feasibility of nCPAP administered with the 2 interfaces (helmet and facial mask). Feasibility was evaluated by the number of trial failures defined as the occurrence of 1 of the following: intolerance to the interface; persistent air leak; gas-exchange derangement; or major adverse events. nCPAP application time, number of patients who required sedation, and the type of complications with each interface were also recorded. The secondary end point was gas-exchange improvement.
RESULTS: Feasibility of nCPAP delivery was enhanced by the helmet compared with the mask, as indicated by a lower number of trial failures (P < .001), less patient intolerance (P < .001), longer application time (P < .001), and reduced need for patient sedation (P < .001). For both delivery methods, no major patient complications occurred. CONCLUSIONS: The results of this current study revealed that the helmet is a feasible alternative to the facial mask for delivery of nCPAP to infants with mild ARF.http://pediatrics.aappublications.org/content/126/2/e330.full.pdf+html
|
| Presión positiva nasal continua (CPAP) para el cuidado respiratorio en el recién nacido |
Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant.
Diblasi RM.
Center for Developmental Therapeutics, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle WA 98101, USA. robert.diblasi@seattlechildrens.org
Respir Care. 2009 Sep;54(9):1209-35.
Abstract
Nasal continuous positive airway pressure (CPAP) is a noninvasive form of respiratory assistance that has been used to support spontaneously breathing infants with lung disease for nearly 40 years. Following reports that mechanical ventilation contributes to pulmonary growth arrest and the development of chronic lung disease, there is a renewed interest in using CPAP as the prevailing method for supporting newborn infants. Animal and human research has shown that CPAP is less injurious to the lungs than is mechanical ventilation. The major concepts that embrace lung protection during CPAP are the application of spontaneous breathing at a constant distending pressure and avoidance of intubation and positive-pressure inflations. A major topic for current research focuses on whether premature infants should be supported initially with CPAP following delivery, or after the infant has been extubated following prophylactic surfactant administration. Clinical trials have shown that CPAP reduces the need for intubation/mechanical ventilation and surfactant administration, but it is still unclear whether CPAP reduces chronic lung disease and mortality, compared to modern lung-protective ventilation techniques. Despite the successes, little is known about how best to manage patients using CPAP. It is also unclear whether different strategies or devices used to maintain CPAP play a role in improving outcomes in infants. Nasal CPAP technology has evolved over the last 10 years, and bench and clinical research has evaluated differences in physiologic effects related to these new devices. Ultimately, clinicians' abilities to perceive changes in the pathophysiologic conditions of infants receiving CPAP and the quality of airway care provided are likely to be the most influential factors in determining patient outcomes.http://www.rcjournal.com/contents/09.09/09.09.1209.pdf
|
|
No hay comentarios:
Publicar un comentario