HYPOXEMIA DURING RECOVERY FROM SEVERE HYALINE MEMBRANE DISEASE

PEDIATRICS ◽  
1969 ◽  
Vol 44 (2) ◽  
pp. 168-178
Author(s):  
T. M. Adamson ◽  
J. M. Hawker ◽  
E. O. R. Reynolds ◽  
J. L. Shaw
Keyword(s):  
Mechanical Ventilation ◽  
Arterial Oxygen Tension ◽  
Hyaline Membrane Disease ◽  
Arterial Oxygen ◽  
Mechanically Ventilated ◽  
Oxygen Breathing ◽  
Arterial Blood ◽  
Hyaline Membrane ◽  
Blood Gas Analyses ◽  
Serial Samples

Serial samples of arterial blood were taken during the illness of 10 infants with severe hyaline membrane disease, four of whom required mechanical ventilation. After the first few days of the illness had passed, there was little true right-to-left shunting of blood, but severe hypoxemia was found during the breathing of room air. Normal gas exchange was present by a mean time of 14 days from birth in infants who did not require mechanical ventilation, but it was delayed for many weeks in mechanically ventilated infants. From the results of blood gas analyses during air and oxygen breathing, it is concluded that hypoxemia during recovery from hyaline membrane disease is probably caused by inequalities of ventilation and perfusion in the lungs. Careful monitoring of the arterial oxygen tension is necessary so that an appropriate concentration of oxygen can be given in the inspired gas.

Early-Onset Haemophilus Sepsis in Newborn Infants: Clinical, Roentgenographic, and Pathologic Features

PEDIATRICS ◽  
1978 ◽  
Vol 62 (3) ◽  
pp. 299-303
Author(s):  
Lawrence D. Lilien ◽  
Tsu F. Yeh ◽  
Gertrude M. Novak ◽  
Norman M. Jacobs
Keyword(s):  
Early Onset ◽  
Polymorphonuclear Leukocytes ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Hyaline Membrane Disease ◽  
Arterial Oxygen ◽  
Pathologic Features ◽  
High Incidence ◽  
Hyaline Membrane ◽  
Time Of Infection

Nine infants with early-onset Haemophilus sepsis were seen between January 1973 and July 1977. Of the five isolated strains that were typed, only one was type B. All infants had respiratory distress, metabolic acidosis, and large alveolar-arterial oxygen tension difference gradients. Eight infants weighed less than 1,500 gm and died; one infant weighed 1,701 gm and survived. Roentgenograms in six of eight showed hyaline membrane disease. Pulmonary pathologic specimens in eight infants revealed hyaline membranes in six and polymorphonuclear leukocytes in the alveolar spaces in four. In two infants, small Gram-negative bacilli were noted within proteinaceous exudates in alveolar ducts. The route and time of infection in these infants with early-onset Haemophilus sepsis are unclear. However, the possibility that the infection occurs before birth and that these infants represent septically aborted prematures is suggested by the high incidence of prematurity in infants with early-onset Haemophilus sepsis and early detection of bacteremia in three infants.

Pulmonary function in the newborn infant: the alveolar-arterial oxygen gradient

1963 ◽  
Vol 18 (3) ◽  
pp. 534-538 ◽  
Author(s):  
Nicholas M. Nelson ◽  
L. Samuel Prod'hom ◽  
Ruth B. Cherry ◽  
Philip J. Lipsitz ◽  
Clement A. Smith
Keyword(s):  
Cardiac Output ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Hyaline Membrane Disease ◽  
Arterial Oxygen ◽  
Venous Admixture ◽  
Oxygen Gradient ◽  
Oxygen Breathing ◽  
Hyaline Membrane ◽  
Washout Curves

The venous admixture component of the total alveolar-arterial gradient for oxygen (AaD-O2) has been measured in 26 normal infants less than 4 days of age and in 12 others with the respiratory distress syndrome (hyaline membrane disease). The AaD-O2 in normal air-breathing infants (average 28 mm Hg) is nearly three times that seen in adults. Analysis of mixing data from N2-washout curves in these infants suggests such excellent distribution of ventilation that the distribution component of the AaD-O2 must be quite small. By contrast, estimates of the shunt component during oxygen breathing reveal a shunt flow in normal infants of nearly one-fourth cardiac output (AaD-O2 = 311) which is further increased in distressed babies (up to two-thirds cardiac output) and which can completely account for the large AaD-O2's found in both groups of infants. Submitted on July 9, 1962

THE SIGNIFICANCE OF GRUNTING IN HYALINE MEMBRANE DISEASE

PEDIATRICS ◽  
1968 ◽  
Vol 41 (3) ◽  
pp. 549-559 ◽  
Author(s):  
V. C. Harrison ◽  
H. de V. Heese ◽  
M. Klein
Keyword(s):  
Oxygen Tension ◽  
Valsalva Maneuver ◽  
Arterial Oxygen Tension ◽  
Hyaline Membrane Disease ◽  
Alveolar Ventilation ◽  
Arterial Oxygen ◽  
Abdominal Muscles ◽  
Intrapleural Pressure ◽  
Hyaline Membrane

Grunting was investigated in 22 infants with hyaline membrane disease. It was demonstrated to be a modified Valsalva maneuver, as during expiration intrapleural pressure was increased by closure of the glottis and contraction of the abdominal muscles. Grunting could be prevented if the trachea was intubated; but, during this period the arterial oxygen tension fell. After detubation grunting recommenced and arterial oxygen tension rose to previous levels. Therefore, grunting appears to be a protective form of breathing, aimed at raising the PaO2. This is probably achieved by improvement of alveolar ventilation, but the exact mechanism is not known.

INDICATIONS FOR MECHANICAL VENTILATION IN INFANTS WITH HYALINE MEMBRANE DISEASE

PEDIATRICS ◽  
1970 ◽  
Vol 46 (2) ◽  
pp. 193-202
Author(s):  
E. O.R. Reynolds
Keyword(s):  
Heart Rate ◽  
Mechanical Ventilation ◽  
Gas Exchange ◽  
Hyaline Membrane Disease ◽  
Controlled Trials ◽  
Blood Gas ◽  
College Hospital ◽  
Mechanically Ventilated ◽  
Hyaline Membrane ◽  
Hazardous Procedure

One hundred and four infants with a diagnosis of hyaline membrane disease who weighed more than 1,000 gm at birth were admitted to the Neonatal Unit of University College Hospital during a period of 3 years. The management of the infants is described. Seventy-two infants survived without mechanical ventilation. The remaining 32 infants became apneic or collapsed with a heart rate of less than 80/minute, did not respond to simple resuscitative measures, and were mechanically ventilated; 7 of these 32 infants survived. Only one infant survived out of a total of 22 infants who became apneic within 24 hours of delivery. Six out of 10 infants survived when apnea occurred later than 24 hours after delivery. It is concluded that mechanical ventilation is unlikely to lead to the survival of the most severely affected infants, and that controlled trials of this form of treatment are both justifiable and desirable so that its effectiveness can be properly assessed. Many infants with very severe abnormalities of gas exchange survived intact without needing mechanical ventilation. Therefore, it may be dangerous to select infants for mechanical ventilation on the basis of blood gas criteria because they may then be unnecessarily subjected to a potentially hazardous procedure.

Hyperoxemia in Newborn Infants: Detection by Pulse Oximetry

PEDIATRICS ◽  
1989 ◽  
Vol 84 (2) ◽  
pp. 226-230
Author(s):  
Hans-Ulrich Bucher ◽  
Sergio Fanconi ◽  
Peter Baeckert ◽  
Gabriel Duc
Keyword(s):  
Pulse Oximetry ◽  
Pulse Oximeter ◽  
Arterial Oxygen Saturation ◽  
Newborn Infants ◽  
Arterial Oxygen Tension ◽  
Arterial Oxygen ◽  
Mechanically Ventilated ◽  
Arterial Blood ◽  
Transcutaneous Monitoring ◽  
Alarm Limit

Pulse oximetry has been proposed as a non-invasive continuous method for transcutaneous monitoring of arterial oxygen saturation of hemoglobin (tcSO2) in the newborn infant. The reliability of this technique in detecting hyperoxemia is controversial, because small changes in saturation greater than 90% are associated with relatively large changes in arterial oxygen tension (PaO2). The purpose of this study was to assess the reliability of pulse oximetry using an alarm limit of 95% tcSO2 in detecting hyperoxemia (defined as PaO2 greater than 90 mm Hg) and to examine the effect of varying the alarm limit on reliability. Two types of pulse oximeter were studied alternately in 50 newborn infants who were mechanically ventilated with indwelling arterial lines. Three arterial blood samples were drawn from every infant during routine increase of inspired oxygen before intratracheal suction, and PaO2 was compared with tcSO2. The Nellcor N-100 pulse oximeter identified all 26 hyperoxemic instances correctly (sensitivity 100%) and alarmed falsely in 25 of 49 nonhyperoxemic instances (specificity 49%). The Ohmeda Biox 3700 pulse oximeter detected 13 of 35 hyperoxemic instances (sensitivity 37%) and alarmed falsely in 7 of 40 nonhyperoxemic instances (specificity 83%). The optimal alarm limit, defined as a sensitivity of 95% or more associated with maximal specificity, was determined for Nellcor N-100 at 96% tcSO2 (specificity 38%) and for Ohmeda Biox 3700 at 89% tcSO2 (specificity 52%). It was concluded that pulse oximeters can be highly sensitive in detecting hyperoxemia provided that type-specific alarm limits are set and a low specificity is accepted.

CARDIORESPIRATORY STATUS OF ERYTHROBLASTOTIC INFANTS

PEDIATRICS ◽  
1972 ◽  
Vol 49 (1) ◽  
pp. 5-14
Author(s):  
R. H. Phibbs ◽  
P. Johnson ◽  
J. A. Kitterman ◽  
G. A. Gregory ◽  
W. H. Tooley
Keyword(s):  
Respiratory Distress ◽  
Distress Syndrome ◽  
Arterial Oxygen Tension ◽  
Hyaline Membrane Disease ◽  
Arterial Oxygen ◽  
Pathologic Finding ◽  
Hyaline Membrane ◽  
Idiopathic Respiratory Distress Syndrome ◽  
Delayed Recovery ◽  
Prematurely Born Infants

We evaluated cardiorespiratory and hematologic status at birth, and changes in arterial oxygen tension and pH during the first hour of life in 61 prematurely born infants with moderate to severe erythroblastosis fetalis and compared the findings with their subsequent neonatal course. Intrapartum asphyxia was common and often followed by respiratory distress of varying severity. Twenty infants died; all had the idiopathic respiratory distress syndrome and pathologic finding of pulmonary hyaline membrane disease. These complications were related to the interacting effects of prematurity, anemia, hydrops fetalis, and intrapartum asphyxia and, in particular, to delayed recovery from asphyxia as manifested by persistent hypoxemia and acidemia during the first hour of life.

CPAP and Mechanical Ventilation

1991 ◽  
Vol 7 (S1) ◽  
pp. 31-40 ◽  
Author(s):  
Gunnar Sedin
Keyword(s):  
Mechanical Ventilation ◽  
Newborn Infants ◽  
Blood Gases ◽  
Hyaline Membrane Disease ◽  
Arterial Blood Gases ◽  
Intermittent Mandatory Ventilation ◽  
New Methods ◽  
Arterial Blood ◽  
Hyaline Membrane ◽  
The 1960S

Respiratory insufficiency has previously been a frequent cause of neonatal death, especially in preterm infants. As late as in 1967, Silverman and associates (66) found that in infants with hyaline membrane disease (HMD), mechanical ventilation with a body-enclosing negative pressure respirator did not improve survival. Before 1970, the mortality among infants who required respiratory therapy was high (20;46;70). At the end of the 1960s and the beginning of the 1970s, several new methods were introduced to improve ventilation of newborn infants. Kirby and coworkers (41) introduced intermittent mandatory ventilation as a way of weaning from mechanical ventilation. In a series of studies, Reynolds and coworkers evaluated the effects of different peak airway pressures, respiratory frequencies, and inspiratory:expiratory ratios on arterial blood gases and right to left shunts (32;58;59;60).

scholarly journals Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinshu Katayama ◽  
Jun Shima ◽  
Ken Tonai ◽  
Kansuke Koyama ◽  
Shin Nunomiya
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Prospective Observational Study ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Arterial Blood Gas ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Arterial Blood ◽  
Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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