Abstract:
OBJECTIVES:We sought to compare gas exchange, respiratory mechanics, and asynchronies during pressure support ventilation (PSV), sigh adjunct to PSV (PSV SIGH), and neurally adjusted ventilatory assist (NAVA) in hypoxemic infants after cardiac surgery. DESIGN:Prospective, single-center, crossover, randomized physiologic study. SETTING:Tertiary-care pediatric intensive care unit. PATIENTS:Fourteen hypoxemic infants (median age 11.5 days [8.7-74]). INTERVENTIONS:The protocol begins with a 1 hour step of PSV, followed by two consecutive steps in PSV SIGH and NAVA in random order, with a washout period of 30 minutes (PSV) between them. MAIN RESULTS:Three infants presented an irregular Eadi signal because of diaphragmatic paralysis and were excluded from analysis. For the remaining 11 infants, PaO2 /FiO 2 and oxygenation index improved in PSV SIGH compared with PSV (P < 0.05) but not in NAVA compared with PSV. PSV SIGH showed increased tidal volumes and lower respiratory rate than PSV (P < 0.05), as well as a significant improvement in compliance with respiratory system indexed to body weight when compared with both PSV and NAVA (P < 0.01). No changes in mean airway pressure was registered among steps. Inspiratory time resulted prolonged for both PSV SIGH and NAVA than PSV (P < 0.05). NAVA showed the higher coefficient of variability in respiratory parameters and a significative decrease in asynchrony index when compared with both PSV and PSV SIGH (P < 0.01). CONCLUSIONS:The adjunct of one SIGH per minute to PSV improved oxygenation and lung mechanics while NAVA provided the best patient-ventilator synchrony in infants after cardiac surgery.
journal_name
Pediatr Pulmonoljournal_title
Pediatric pulmonologyauthors
Bonacina D,Bronco A,Nacoti M,Ferrari F,Fazzi F,Bonanomi E,Bellani Gdoi
10.1002/ppul.24335subject
Has Abstractpub_date
2019-07-01 00:00:00pages
1078-1086issue
7eissn
8755-6863issn
1099-0496journal_volume
54pub_type
杂志文章,随机对照试验abstract:RATIONAL:This study aims at describing the use of bilevel positive airway pressure (BiPAP) in infants with severe bronchiolitis. WORKING HYPOTHESIS:The use of BiPAP in infants with bronchiolitis may be associated with a worst outcome. STUDY DESIGN:A single-center retrospective study performed from October 2013 to Apr...
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journal_title:Pediatric pulmonology
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abstract::With dual energy X-ray absorptiometry (DEXA), it is possible to quantitate important aspects of growth in children with cystic fibrosis (CF), supplementing the usual measures of height and weight. Of particular concern during growth is the accumulation of bone mineral, since osteoporosis and fractures are well-recogni...
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journal_title:Pediatric pulmonology
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journal_title:Pediatric pulmonology
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journal_title:Pediatric pulmonology
pub_type: 评论,杂志文章
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journal_title:Pediatric pulmonology
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