Abstract:
OBJECTIVE:To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN:Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING:Paediatric and neonatal intensive care units and paediatric wards. PATIENTS:88 Infants and young children aged 1 day to 2 years with respiratory failure due to bronchopulmonary dysplasia, the neonatal respiratory distress syndrome, bronchiolitis, myopathy, the congenital hypoventilation syndrome, pneumonitis, and postoperative phrenic nerve palsy. At the start of treatment 59 were receiving greater than or equal to 50% inspired oxygen and 40 positive airway pressure ventilation. INTERVENTION:Treatment was provided within purpose built Perspex chambers of appropriate size. The chamber incorporated safe and effective latex neck seals; facilities for access, monitoring, and observation; and a heater to control the ambient air temperature. MAIN OUTCOME MEASURES:Inspired oxygen concentration and carbon dioxide pressure before application of negative extrathoracic pressure and two and 48 hours afterwards; duration of treatment; and final outcome (discharge home or death). RESULTS:While arterial oxygen saturation was maintained at constant values 75 infants showed reductions in inspired oxygen concentrations (range 4-50%, median 15%) two hours after starting treatment and 74 showed reductions at 48 hours (2-79%, median 20%). Of 59 infants who had carbon dioxide pressure measured before and after starting negative extrathoracic pressure, 21 showed a reduction (range 0.6-8.9 kPa, median 2.0), 30 no change (+/- 0.5 kPa), and eight a rise (range 0.6-5.1 kPa, median 2.1). In 28 patients extubation was facilitated, 54 patients were discharged home, where six continued treatment, and 34 died. Treatments lasted for between two and 236 days (median 13 days). CONCLUSION:Negative pressure respiratory support is a non-invasive yet effective treatment for respiratory failure. It may avoid the need for intubation, reduce the pathophysiological consequences of positive airway pressure ventilation, and aid extubation.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Samuels MP,Southall DPdoi
10.1136/bmj.299.6710.1253subject
Has Abstractpub_date
1989-11-18 00:00:00pages
1253-7issue
6710eissn
0959-8138issn
1756-1833journal_volume
299pub_type
临床试验,杂志文章abstract:OBJECTIVE:To compare the effectiveness of classroom based cognitive behavioural therapy with attention control and usual school provision for adolescents at high risk of depression. DESIGN:Three arm parallel cluster randomised controlled trial. SETTING:Eight UK secondary schools. PARTICIPANTS:Adolescents (n=5030) ag...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
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更新日期:2012-10-05 00:00:00
abstract:OBJECTIVES:To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. DESIGN:Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta...
journal_title:BMJ (Clinical research ed.)
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更新日期:2007-01-13 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1994-03-05 00:00:00
abstract::Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestatio...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3677
更新日期:2017-08-17 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.297.6646.465
更新日期:1988-08-13 00:00:00
abstract:OBJECTIVES:To relate cancer since entry into the Framingham Heart Study with the risk of incident Alzheimer's disease and to estimate the risk of incident cancer among participants with and without Alzheimer's disease. DESIGN:Community based prospective cohort study; nested age and sex matched case-control study. SET...
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更新日期:2012-03-12 00:00:00
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pub_type: 新闻
doi:
更新日期:2000-09-09 00:00:00
abstract::Recent changes in the Russian government introduced by Boris Yeltsin include the appointment of Eduard Nechaev as health minister at the beginning of this year. The appointment received little publicity in the West, although his predecessor was sacked after only one year for failing to make any effort to improve healt...
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pub_type: 杂志文章
doi:10.1136/bmj.306.6882.909
更新日期:1993-04-03 00:00:00
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pub_type: 杂志文章
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更新日期:1991-10-19 00:00:00
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pub_type: 杂志文章
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更新日期:1991-05-11 00:00:00
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pub_type: 杂志文章
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更新日期:2002-11-09 00:00:00
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pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e4972
更新日期:2012-08-22 00:00:00
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journal_title:BMJ (Clinical research ed.)
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doi:10.1136/bmj.c4978
更新日期:2010-10-04 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.317.7154.322
更新日期:1998-08-01 00:00:00
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doi:10.1136/bmj.301.6750.470
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pub_type: 杂志文章,meta分析
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更新日期:2013-02-14 00:00:00
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更新日期:1990-05-05 00:00:00
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更新日期:1998-10-31 00:00:00
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更新日期:1991-01-12 00:00:00
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2018-07-19 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.300.6734.1229
更新日期:1990-05-12 00:00:00
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更新日期:2003-06-21 00:00:00
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更新日期:2016-04-06 00:00:00
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更新日期:1995-09-23 00:00:00