scholarly journals Modified lung ultrasound score predicts ventilation requirements in neonatal respiratory distress syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Piotr Szymański ◽  
Piotr Kruczek ◽  
Roman Hożejowski ◽  
Piotr Wais
Keyword(s):  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Rating Scale ◽  
Lung Ultrasound ◽  
Interrater Agreement ◽  
Respiratory Support ◽  
Invasive Ventilation ◽  
Cronbach's Alpha

Abstract Background We propose a modified lung ultrasound (LUS) score in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The purpose of this study was to evaluate the reproducibility of the rating scale and its correlation with blood oxygenation and to assess the ability of early post-birth scans to predict the mode of respiratory support on day of life 3 (DOL 3). As a secondary objective, the weight of posterior scans in the overall LUS score was assessed. Methods We analyzed 619 serial lung scans performed in 70 preterm infants < 32 weeks gestation and birth weight < 1500 g. Assessments were performed within 24 h of birth (LUS0) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS scores were correlated with oxygen saturation over fraction of inspired oxygen (S/F) and mode of respiratory support. Interrater agreement was determined with the intraclass correlation coefficient (ICC) and Cronbach’s alpha. Probabilities of the need for various respiratory support modes on DOL 3 were assessed with ordinal logistic regression. Least square (ls) means of the posterior and anterior pulmonary field scores were compared. Results The LUS score correlated significantly with S/F (Spearman rho = −0.635; p < 0.0001) and had excellent interrater agreement (ICC = 0.94, 95% CI 0.93–0.95; Cronbach’s alpha = 0.99). Significant predictors of ventilation requirements on DOL 3 were LUS0 (p < 0.016) and birth weight (BW) (p < 0.001). In the ROC analysis, LUS0 had high reliability in prognosing invasive ventilation on DOL 3 (AUC = 0.845 (95% DeLong CI: 0.738–0.951; p < 0.001)). Invasive ventilation was the most likely mode of respiratory support for LUS0 scores: ≥7 (in infants with BW 900 g), ≥ 10 (in infants with BW 1050 g) and ≥ 15 (in infants with BW 1280 g). Posterior fields exhibited significantly higher average scores than anterior fields. Respective ls means (confidence levels) were 4.0 (3.8–4.1) vs. 2.2 (2.0–2.4); p < 0.001. Conclusions Post-birth LUS predicts ventilation requirements on DOL 3. Scores of posterior pulmonary fields have a predominant weight in the overall LUS score.

scholarly journals A Modified Lung Ultrasound Score for Assessing Oxygenation Status and Predicting the Need for Invasive Ventilation in Preterm Neonates with RDS

2020 ◽  
Author(s):  
Piotr Szymański ◽  
Piotr Kruczek ◽  
Roman Hożejowski ◽  
Piotr Wais
Keyword(s):  
Birth Weight ◽  
Rating Scale ◽  
Lung Ultrasound ◽  
Dominant Role ◽  
Interrater Agreement ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Invasive Ventilation ◽  
Dominant Weight ◽  
Ultrasound Score

Abstract PurposeWe propose a modified lung ultrasound score (LUS) in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The LUS was evaluated for validity, interrater agreement and prognostic power in relation to the need for respiratory support on day of life (DOL) 3. The hypothesis of the dominant weight of posterior scans in the LUS was also verified.Materials and methodsA total of 647 serial lung scans were performed in 70 preterm infants <32 weeks gestation and birth weight <1500 g. Assessments were performed within 24 hours of birth (LUS0) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS was correlated to oxygen saturation over fraction of inspired oxygen (SpO2/FiO2) and mode of respiratory support. Probabilities of the need for respiratory support on DOL 3 were assessed with ordinal logistic regression.ResultsThe LUS correlated significantly with SpO2/FiO2 (Spearman rho = -0.635; p<0.0001) and had excellent interrater agreement (Cronbach’s alpha = 0.99). Posterior fields had dominant weight over the anterior fields (ls mean [confidence level]) 4.0 [3.8–4.1] vs 2.2 [2.0–2.4]; p<0.0001. Significant predictors of ventilation requirements on DOL 3 were LUS0 (p<0.016) and birth weight (BW) (p<0.0001); invasive ventilation was the most likely option with LUS0 ≥7 (BW 900 g), ≥10 (BW 1050 g) and ≥15 (BW 1280 g).ConclusionPostbirth LUS predicts the need for mechanical ventilation on DOL 3. Posterior fields play a dominant role in sonographic assessment of lungs in neonatal RDS.

scholarly journals A Comparison of Leak Synchronized Nasal SIMV Methods and Leak Compensated Nasal SIMV in Newborns with Respiratory Distress Syndrome

2021 ◽  
pp. 18-21
Author(s):  
Ahmet Özdemir ◽  
Mustafa Ali Akın ◽  
Osman Baştug ◽  
Tamer Güneş
Keyword(s):  
Blood Pressure ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Distress Syndrome ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Significant Difference

The aim of the present study was to compare the efficacy of leak compensated nasal SIMV (LCnSIMV) and leak synchronized nasal SIMV (LSnSIMV) modes in order to reduce the need for endotracheal intubation and associated complications in newborns with respiratory distress. This randomized, prospective study was conducted on 50 infants (25 per group) with gestational age below 34 weeks and/or below 2000 grams who have been admitted to NICU of Erciyes University Hospital because of respiratory distress syndrome (RDS) and need for mechanical ventilation. Infants with congenital heart disease, nasopharyngeal pathology (coanal atresia and cleft palate-lip) were excluded. Infants monitored on mechanical ventilator after surfactant were randomly assigned to LCnSIMV and LSnSIMV groups before extubation. SPO2/FiO2 (S/F), peak heart rate (PHR), respiration rate per minute (RRM), and arterial blood pressure (aBP) values of patients were recorded. Gestational age, birth weight, gender, RDS, patent ductus arteriosus (PDA) requiring treatment, presence of intraventricular bleeding (IVH), retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) were recorded. The patients enrolled in the study were female by 48% and male by 52%. There was not any statistically significant difference between groups for gender, postnatal age and birth weight. There was detected statistically significant difference between LCnSIMV and LSnSIMV groups for non-invasive ventilation period and re-intubation rate (p=0.04 and p=0.03, respectively). There was detected statistically significant difference between LCnSIMV and LSnSIMV groups for SpO2 and S/F rates at 60 minutes (p=0.03 and p=0.01, respectively). There was not any difference between groups for blood pressure, PDA, IVH, ROP, BPD, NEC, sepsis and air leak. It may be appropriate to prefer the LSnSIMV method in patients with respiratory distress syndrome who need non-invasive ventilation in the pre-extubation period by considering the patient-ventilator compliance for positive effect in terms of mechanical clinical variables.

Role of lung ultrasound in the assessment of recruitment maneuvers in ventilated preterm neonates with respiratory distress syndrome and its correlation with tracheal IL-6 levels: A randomized controlled trial

2020 ◽  
pp. 1-6
Author(s):  
N.M.A. Shady ◽  
H.A.S. Awad ◽  
D.R. Kamel ◽  
E.M. Fouda ◽  
N.T. Ahmed ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Lung Ultrasound ◽  
Controlled Trial ◽  
Controlled Study ◽  
Preterm Neonates ◽  
Invasive Ventilation ◽  
Randomized Controlled ◽  
Group I

BACKGROUND: This study’s aim is to evaluate lung ultrasound (LUS) efficacy in detecting opening and closing lung pressures and its correlation with the tracheal interleukin 6 (IL-6) level. METHOD: This single-blinded randomized controlled study was done at Ain Shams University Children’s Hospital neonatal intensive care units, Egypt. It consists of 44 mechanically ventilated preterm neonates with Respiratory Distress Syndrome (RDS). Initial LUS assessment was done followed by randomization to one of 2 groups; group I: 22 patients underwent LUS guided RM and group II: 22 patients underwent non-ultrasound guided RM. Tracheal IL-6 level was measured before and after RM in both groups. RESULTS: The LUS scores showed a sensitivity of 86.7% , specificity of 62.10% and accuracy of 70.45% at the cut-off point >B1 grade. After RM, there was a higher percentage of changes in mean airway pressure (p = 0.03), FiO2 (p = 0.01), PaO2/FiO2 ratio (p = 0.01), and IL-6 (p <  0.01) in group I. The duration of oxygen requirement (6 vs.13.5 days, p = 0.01), invasive ventilation (3 vs.5.5 days, p = 0.03), non-invasive ventilation (2.5 vs. 5 days, p = 0.02) and NICU stay (21.5 vs. 42.5 days, p = 0.03) was less in group I. A positive correlation between reaeration score and the duration of O2 requirement (p = 0.002), duration of invasive ventilation (p = 0.001), NICU length of stay (p = 0.002) and negative correlation with PaO2/FiO2 ratio before RM (p = 0.012). The best cut-off point for the reaeration score is >21 with a sensitivity of 75% , specificity of 71.43% and area under the curve of 78.1% . CONCLUSION: LUS-guided RM achieved earlier lowest FiO2, shorter O2 dependency, lesser NICU stay and marked decrease in lung inflammation by decreasing atelectotrauma and shortening the duration of invasive ventilation.

scholarly journals Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arash Malakian ◽  
Mohammad Reza Aramesh ◽  
Mina Agahin ◽  
Masoud Dehdashtian
Keyword(s):  
Mechanical Ventilation ◽  
Continuous Positive Airway Pressure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Positive Airway Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Abstract Background The most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications. Methods 148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications. Results there was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002). Conclusions In the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group. Trial registration IRCT20180821040847N1, Approved on 2018-09-10.

Predictors of mortality in premature babies with respiratory distress syndrome treated by early rescue surfactant therapy

2021 ◽  
pp. 1-6
Author(s):  
V. Gahlawat ◽  
H. Chellani ◽  
I. Saini ◽  
S. Gupta
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Mask Ventilation ◽  
Predictors Of Mortality ◽  
Antenatal Steroid ◽  
Bag And Mask Ventilation

OBJECTIVE: To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. STUDY DESIGN: Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. RESULTS: Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g and 31.40 (±2.0)1 weeks, respectively. Birth weight <  1500 g, gestational age <  32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. CONCLUSIONS: Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies.

Early versus late treatment of neonatal acidosis in low-birth-weight infants: Relation to respiratory distress syndrome

1972 ◽  
Vol 81 (6) ◽  
pp. 1178-1187 ◽  
Author(s):  
Calvin J. Hobel ◽  
William Oh ◽  
Marcia A. Hyvarinen ◽  
George C. Emmanouilides ◽  
Allen Erenberg
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Low Birth Weight Infants ◽  
Late Treatment

Passage of the First Stool in Very Low Birth Weight Infants

PEDIATRICS ◽  
1987 ◽  
Vol 79 (6) ◽  
pp. 1005-1007
Author(s):  
Meenakshi K. Jhaveri ◽  
Savitri P. Kumar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Very Low Birth Weight ◽  
Gut Hormones ◽  
Low Birth Weight Infants ◽  
Severe Respiratory Distress ◽  
Severe Respiratory Distress Syndrome

Times of first stool passage were studied in 171 infants who weighed less than 1,500 g at birth. Delayed passage (greater than 48 hours) was noted in 20.4% of this group. Significant differences were noted between the delayed and nondelayed groups for gestational age, presence of severe respiratory distress syndrome, and the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiologic immaturity of the motor mechanisms of the gut, lack of triggering effect of enteral feeds on gut hormones, and the presence of severe respiratory distress syndrome, which may singly or in concert adversely affect gastrointestinal motility.

Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits

2021 ◽  
Vol 82 (6) ◽  
pp. 1-9
Author(s):  
M Gabrielli ◽  
F Valletta ◽  
F Franceschi ◽  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.

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