Intraoperative High-Frequency Jet Ventilation Is Equivalent to Conventional Ventilation During Patent Ductus Arteriosus Ligation

2017 ◽  
Vol 8 (5) ◽  
pp. 570-574 ◽  
Author(s):  
Mackenzie Noonan ◽  
Joseph W. Turek ◽  
John M. Dagle ◽  
Steven J. McElroy
Keyword(s):  
Patent Ductus Arteriosus ◽  
High Frequency ◽  
Ductus Arteriosus ◽  
Conventional Ventilation ◽  
Jet Ventilation ◽  
Children's Hospital ◽  
High Frequency Jet Ventilation ◽  
Pda Ligation ◽  
The University ◽  
Patent Ductus

Background: Patent ductus arteriosus (PDA) treatment is typically pharmacologic, but if unsuccessful, surgical ligation is commonly performed. High-frequency jet ventilation (HFJV) is used at the University of Iowa Stead Family Children’s Hospital for extremely low birth weight infants. Historically, neonates requiring PDA ligation were temporarily transferred to conventional ventilation (CV) prior to surgery. Objective: The objective of this study was to determine whether conversion was necessary. Methods: This retrospective cohort analysis examined outcomes following PDA ligation from 2014 to 2016 at the University of Iowa’s Stead Family Children’s Hospital. Infants who were transferred to CV prior to surgery and returned to HFJV postprocedure are referred to as the CV cohort. The HFJV cohort infants remained on HFJV throughout. Results: We found no significant increases in morbidity or mortality with the use of intraoperative HFJV and potentially show some benefit through greater reduction in serum CO2. Conclusions: Mode of ventilation during PDA ligation does not affect surgical morbidity or mortality or short-term clinical outcomes. Conversion to CV from HFJV is not necessary.

The Silent Patent Ductus Arteriosus

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 581-582
Author(s):  
R. CURTIS ELLISON ◽  
GEORGE J. PECKHAM ◽  
PETER LANG ◽  
NORMAN S. TALNER ◽  
TRUDY S. LERER ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Distress Syndrome ◽  
Ductus Arteriosus ◽  
High Specificity ◽  
University Of California ◽  
Toxic Drug ◽  
Prime Concern ◽  
The University ◽  
Work Done ◽  
Patent Ductus

In Reply.— We appreciate the comments of Kashani, Swensson and Merritt. We are cognizant of the pioneering work done through the years at the University of California at San Diego in relation to the management of respiratory distress syndrome (RDS). The multicenter trial1 established diagnostic criteria for patent ductus arteriosus (PDA) in 1978. In view of the unknown toxicity of indomethacin at that time, high specificity rather than maximum sensitivity was of prime concern. We wanted to enroll in our trial only those infants in whom the degree of ductal shunting was leading to sufficient cardiopulmonary compromise to cause a threat to the infant and to warrant the use of a potentially toxic drug or surgery.

Bronchoscopic Findings in Infants Treated With High-Frequency Jet Ventilation Versus Conventional Ventilation

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 884-887
Author(s):  
Carolyn M. Kercsmar ◽  
Richard J. Martin ◽  
Robert L. Chatburn ◽  
Waldemar A. Carlo
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
High Frequency ◽  
Distress Syndrome ◽  
Conventional Ventilation ◽  
Jet Ventilation ◽  
Short Term ◽  
Short Term Treatment ◽  
High Frequency Jet Ventilation ◽  
Necrotizing Tracheobronchitis

To identify tracheobronchial abnormalities associated with assisted ventilation, 40 infants with respiratory distress syndrome randomized to receive either short-term (48 hours) conventional or high-frequency jet ventilation were studied. Flexible fiberoptic bronchoscopy (n = 13) was performed and/or clinical and radiographic assessments were used to evaluate for laryngeal, tracheal, and bronchial lesions. There was no bronchoscopic evidence of necrotizing tracheobronchitis after either high-frequency jet ventilation (n = 8) or conventional ventilation (n = 5). Laryngotracheomalacia and nodular vocal cords were the most common abnormalities noted, and they occurred with equal frequency in both groups. Study infants who were not bronchoscoped had no clinical or radiographic evidence of tracheal or mainstem bronchial obstruction. One patient did have microscopic evidence of necrotizing tracheobronchitis at autopsy, however. It is concluded that short-term treatment of respiratory distress syndrome with high-frequency jet ventilation may be performed without undue risk of tracheobronchial injury.

Rectal Acetaminophen Improves Shunt Volume and Reduces Patent Ductus Arteriosus Ligation in Extremely Preterm Infants

2021 ◽  
Author(s):  
Michael P. Castaldo ◽  
Elaine Neary ◽  
Adrianne R. Bischoff ◽  
Dany E. Weisz ◽  
Amish Jain ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Septal Defect ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Cyclooxygenase Inhibitors ◽  
Composite Outcome ◽  
Shunt Volume ◽  
Pda Ligation ◽  
Patent Ductus

Objective An alternative therapy for preterm infants with a hemodynamically significant patent ductus arteriosus (hsPDA) is needed when cyclooxygenase inhibitors fail or where treatment is contraindicated due to coexisting renal failure, necrotizing enterocolitis, and/or intestinal perforation. No studies have evaluated the efficacy of per rectum (PR) acetaminophen. The study aimed to evaluate the efficacy of PR acetaminophen in modulating the risk of PDA ligation. Study Design A retrospective matched case–control study was conducted to compare neonates born <29 weeks' gestation with evidence of hsDA, in an era when rescue rectal acetaminophen was used (January 2014–March 2018) as a treatment strategy, versus historical controls (July 2006–August 2012). All patients underwent comprehensive echocardiography assessment of ductal shunt volume according to a standardized protocol. Acetaminophen treated neonates were matched according to demographics, gestation, preintervention echocardiography features, and comorbidities. Control patients were selected when an echocardiography was performed at an equivalent postnatal age. Infants with a genetic syndrome, severe congenital malformation, or major forms of congenital heart disease excluding small atrial septal defect or ventricular septal defect, PDA, or patent formale ovale were excluded. The primary outcome was surgical ligation of the PDA. Secondary outcomes included echocardiography indices of hemodynamic significance, the composite of death, or severe BPD (defined by ventilator dependence at 36 weeks postmenstrual age). Descriptive statistics and univariate (t-tests, Fisher's exact test, and Mann–Whitney U test) analyses were used to evaluate clinical and echocardiography characteristics of the groups and compare outcomes. Results Forty infants (20 cases and 20 controls), with similar demographic and echocardiography features, were compared. Cases received 6.8 ± 0.7 days (60 mg/kg/day) of PR acetaminophen. Responders (n = 12, 60%) had echocardiography evidence of reduced ductal diameter (2.2 mm [1.9–2.6] to 1.1 mm [0–1.7], p = 0.002), left ventricular output (363 ± 108–249 ± 61 mL/min/kg; p = 0.002) and left atrium to aortic root ratio (1.7 ± 0.3–1.3 ± 0.2; p = 0.002) following treatment. The rate of PDA ligation was 50% lower (p = 0.02) and composite outcome of death or severe bronchopulmonary dysplasia was reduced (p = 0.04) in the acetaminophen group. Conclusion Rectal acetaminophen was associated with improvement in echocardiography indices of PDA shunt volume, a 50% reduction in PDA ligation rates and a reduction in the composite outcome of death or severe BPD. Pharmacologic and further prospective clinical studies are needed. Key Points

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