scholarly journals The using of a neurally adjusted ventilatory assist in premature infants. Article

2020 ◽  
pp. 122-128
Author(s):  
A. M Anuriev ◽  
V. I Gorbachev ◽  
T. M Anurieva ◽  
I. L Petrova
Keyword(s):  
Partial Pressure ◽  
Premature Infants ◽  
Venous Blood ◽  
Study Groups ◽  
Neurally Adjusted Ventilatory Assist ◽  
Gas Composition ◽  
Partial Pressure Of Oxygen ◽  
Intermittent Mandatory Ventilation ◽  
Ventilatory Assist ◽  
Excess Base

Introduction. The problem of choosing an adequate mode and parameters of mechanical ventilation (MV) in premature infants remains extremely important in neonatology. Objectives. To assess the effect of nerve-regulated MV on the gas composition of the blood, the concentration of malondialdehyde (MDA) and glutathione in premature infants. Materials and methods. The study included 46 premature infants who underwent MV from birth. The gestational age of children was 25-32 weeks, birth weight - 520-1100 grams. Two study groups were formed. The first group consisted of newborns with respiratory support in the Synchronized Intermittent Mandatory Ventilation (SIMV), the second group consisted of children who underwent Neurally Adjusted Ventilatory Assist (NAVA).At birth and during the first three days, the parameters of the gas composition of venous blood are measured: pH, pCO2, pO2, BE; lactate level. Concentrations of MDA and glutathione determine the first and seventh days of life. Results. In children of the first group, hypocapnia was observed during the first three days of life, while the minimum level of partial pressure of carbon dioxide (pCO2) was observed on the first day and amounted to 32.0 (24.9; 37.8) mm Hg. In patients of the second group, pCO2 indices were close to the reference ones and amounted to 36.0 (32.5; 42.2) mm Hg (p = 0.01).Indicators of excess base (BE) were reduced in patients in both groups and on the third day amounted to -6.4 (-7.4;-5.2) mmol/l in children of the first group and -4.7 (-6.0;-3.1) mmol/l in children of the second group (p = 0.02). No statistically significant differences in the partial pressure of oxygen (pO2), lactate, and glutathione were observed. Values of MDA were increased in patients of the first and second groups, however, a decrease in its concentration was observed in the dynamics in both groups. On the 7th day, in patients of the first group, the concentration of malondialdehyde decreased from 13.4 nmol/l to 12.0 nmol/l. In patients of the second group, its indices decreased twofold from the initial ones and amounted to 6.3 (5.4; 7.4) nmol/l (p = 0.01). Conclusion.The use of NAVA ventilation in premature infants ensures a constant gas composition of the blood, and also prevents the activation of lipid peroxidation resulting from hypoxia.

scholarly journals Neurally Adjusted Ventilatory Assistance and Synchronized Intermittend Mandatory Ventilation in Children Assessed by Electrical Impedance Segmentography: A Prospective Randomized Case-Control Crossover Trial

2021 ◽  
Author(s):  
Jennifer Bettina Brandt ◽  
Alex Mahlknecht ◽  
Tobias Werther ◽  
Roman Ullrich ◽  
Michael Hermon
Keyword(s):  
Electrical Impedance ◽  
Crossover Trial ◽  
Case Control ◽  
Dynamic Monitoring ◽  
Limiting Factors ◽  
Neurally Adjusted Ventilatory Assist ◽  
Electric Impedance ◽  
Intermittent Mandatory Ventilation ◽  
Tertiary Center ◽  
Ventilatory Assist

Abstract Background: Assessing relative differences of integrated impedance as a surrogate of volume changes between neurally adjusted ventilatory assist (NAVA) and synchronized intermittent mandatory ventilation (SIMV) by using electric impedance segmentography in children.Methods: Performed as a prospective randomized case-control crossover trial in a pediatric intensive care unit of a tertiary center including eight mechanically-ventilated children, four sequences of two different ventilation modes were consecutively applied. The children were randomized in two groups; one that was started on neurally adjusted ventilatory assist and the other on synchronized intermittent mandatory ventilation. During ventilation, electric impedance segmentography measurements were recorded.Results: The relative difference of vertical impedance between both ventilatory modes was measured (median 0.52, IQR 0-0.87). These differences in left apical lung segments were present during the first (median 0.58, IQR 0-0.89, p=0.04) and second crossover (median 0.50, IQR 0-0.88, p=0.05) as well as across total impedance (0.52 IQR 0-0.87; p=0.002). During neurally adjusted ventilatory assist children showed a shift of impedance towards caudal lung segments, compared to synchronized intermittent mandatory ventilation.Conclusion: Electrical impedance segmentography enables dynamic monitoring of transthoracic impedance. Segmental measurements, however, were of low reproducibility due to various limiting factors in its application. For further evaluation, larger prospective clinical trials are necessary.

Noninvasive Neurally Adjusted Ventilatory Assist in Premature Infants Postextubation

2016 ◽  
Vol 34 (06) ◽  
pp. 593-598 ◽  
Author(s):  
Tarah Colaizy ◽  
Gary Kummet ◽  
Colleen Kummet ◽  
Jonathan Klein
Keyword(s):  
Premature Infants ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist

Continuous Monitoring of the Partial Pressure of Oxygen in Cerebral Venous Blood

Neurosurgery ◽  
1997 ◽  
Vol 41 (2) ◽  
pp. 462-468 ◽  
Author(s):  
Andreas Rieger ◽  
Matthias Menzel ◽  
Rainov Nikolai G. ◽  
Lhagva Sanchin ◽  
Stephan Rot ◽  
...  
Keyword(s):  
Partial Pressure ◽  
Continuous Monitoring ◽  
Venous Blood ◽  
Partial Pressure Of Oxygen

scholarly journals The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia

2020 ◽  
Vol 17 (6) ◽  
pp. 1845
Author(s):  
Giulia Cannata ◽  
Luciana Abate ◽  
Chiara Scarabello ◽  
Monica Rubini ◽  
Alessandra Giacometti ◽  
...  
Keyword(s):  
Case Report ◽  
Oxygen Saturation ◽  
Partial Pressure ◽  
Venous Blood ◽  
Nasal Cannula ◽  
Partial Pressure Of Oxygen ◽  
Blood Oxygen Saturation ◽  
Peripheral Oxygen Saturation ◽  
Methemoglobin Level ◽  
Arterial Blood

Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal any signs of disease. A venous blood sample showed chocolate-colored blood with a pH of 7.404, a partial pressure of CO2 (pCO2) of 40.6 mmHg, a partial pressure of oxygen (pO2) of 21.3 mmHg, a bicarbonate level of 24 mmol/L, and an oxygen saturation (SO2%) of 47.7%. CO-oximetry carried out simultaneously identified a methemoglobin level of 22%. MET was suspected, and oxygen via nasal cannula at a rate of 4 L/min was given with only a slight increase in oxygen saturation (96%). Slow intravenous injection of methylene blue 1 mg/kg over a period of 5 min was initiated. The peripheral oxygen saturation (SpO2) gradually improved to 100% over the next 20 min. Forty minutes later, venous blood gas analysis showed a methemoglobin level of 0.9% with a complete resolution of cyanosis; supplemental oxygen via nasal cannula was therefore discontinued. During the next 36 h, the patient remained hemodynamically stable with good oxygenation on room air. Conclusions: This case report shows that recognition of acquired MET in a child with sudden cyanosis onset requires a high index of suspicion. In daily activities, there is a need to pay particular attention when homemade vegetable soups for child alimentation are prepared. The consumption of vegetable soups must occur immediately after preparation. Storage in a refrigerator must last no more than 24 h and if longer storage is needed, vegetable soups should be frozen.

scholarly journals Застосування режиму штучної вентиляції легень у новонароджених з гіпоксично-ішемічною енцефалопатією

2019 ◽  
pp. 102-111
Author(s):  
D. M. Surkov
Keyword(s):  
Analysis Of Variance ◽  
Pressure Support Ventilation ◽  
Pressure Support ◽  
Pressure Control ◽  
Volume Control ◽  
Neurally Adjusted Ventilatory Assist ◽  
Anova Analysis ◽  
Intermittent Mandatory Ventilation ◽  
Support Ventilation ◽  
Ventilatory Assist

Респіраторна підтримка вважається одним з головних компонентів інтенсивної терапії доношених новонароджених з помірною або тяжкою гіпоксично-ішемічною енцефалопатією (ГІЕ). Більшість авторів рекомендують проведення штучної вентиляції легень протягом періоду лікувальної гіпотермії та раннього періоду після зігрівання. Традиційно в новонароджених застосовується вентиляція з контролем тиску в дихальних шляхах, недоліком якої є можливі значні коливання рівня СО2, що впливає на церебральну перфузію. Альтернативою може бути новітній режим вентиляції Neurally Adjusted Ventilatory Assist (NAVA). Існує певна кількість досліджень застосування режиму NAVA в немовлят, як доношених, так і недоношених, але його вплив на церебральну перфузію порівняно з традиційними режимами не вивчений. Мета роботи. Порівняти вплив NAVA та інших режимів штучної вентиляції легень на стан мозкового кровотоку в гострому періоді ГІЕ в доношених новонароджених. Матеріали і методи. Досліджено 205 доношених новонароджених з ГІЕ за шкалою Sarnat II–III ст. у терміні ≤ 72 годин після пологів. Немовлята були розподілені методом простої відкритої рандомізації за режимами штучної вентиляції легень на групу NAVA (n = 18) та групу контролю (n = 187), яку в подальшому було стратифіковано на підгрупи із застосуванням режимів Pressure Control (РС) (n = 152), Synchronized Intermittent Mandatory Ventilation / Pressure Support Ventilation (SIMV/PSV) (n = 16) та Pressure Regulated Volume Control (PRVC) (n = 19). Проведений порівняльний аналіз впливу NAVA та інших режимів вентиляції на стан церебральної перфузії в гострому періоді неонатальної ГІЕ. Результати та обговорення. Порівняно з традиційними режимами вентиляції PC, SIMV/PSV та PRVC на фоні респіраторної підтримки в режимі NAVA отримані достовірно кращі показники доплерівських індексів мозкового кровотоку RI (0,66 [0,58–0,72] проти 0,70 [0,67–0,74], р = 0,021) та РІ (1,2 [1,0–1,40] проти 1,3 [1,2–1,5], р = 0,032) на 3-й день дослідження, наприкінці періоду лікувальної гіпотермії та початку зігрівання. Проведений у подальшому мультиваріантний дисперсійний аналіз ANOVA (analysis of variance) підтвердив позитивний вплив режиму NAVA на церебральну перфузію (р = 0,009), але не виявив достовірного зв’язку з індексами мозкового кровотоку при застосуванні режимів PC (р = 0,140), SIMV/PSV (р = 0,446) та PRVC (р = 0,601). Висновки. Режим вентиляції NAVA має кращий вплив на індекси церебральної перфузії в доношених новонароджених у гострому періоді ГІЕ порівняно з традиційними режимами PC, SIMV/PSV та PRVC.

scholarly journals Monocrotaline pyrrole induces pulmonary endothelial damage through binding to and release from erythrocytes in lung during venous blood reoxygenation

2019 ◽  
Vol 316 (5) ◽  
pp. L798-L809 ◽  
Author(s):  
Rui Xiao ◽  
Liping Zhu ◽  
Yuan Su ◽  
Jiwei Zhang ◽  
Yankai Lu ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Pulmonary Hypertension ◽  
Partial Pressure ◽  
Venous Blood ◽  
Endothelial Damage ◽  
Toxic Metabolite ◽  
Partial Pressure Of Oxygen ◽  
Standard Dosage ◽  
Arterial Blood ◽  
Monocrotaline Pyrrole

Monocrotaline has been widely used to establish an animal model of pulmonary hypertension, most frequently in rats. An important feature of this model resides in the selectivity of monocrotaline injury toward the pulmonary vascular endothelium versus the systemic vasculature when administrated at standard dosage. The toxic metabolite of monocrotaline, monocrotaline pyrrole, is transported by erythrocytes. This study aimed to reveal whether partial pressure of oxygen of blood determined the binding and release of monocrotaline pyrrole from erythrocytes in rats with one subcutaneous injection of monocrotatline at the standard dosage of 60 mg/kg. Our experiments demonstrated that monocrotaline pyrrole bound to and released from erythrocytes at the physiological levels of partial pressure of oxygen in venous and arterial blood, respectively, and then aggregated on pulmonary artery endothelial cells. Monocrotaline pyrrole-induced damage of endothelial cells was also dependent on partial pressure of oxygen. In conclusion, our results demonstrate the importance of oxygen partial pressure on monocrotaline pyrrole binding to erythrocytes and on aggregation and injury of pulmonary endothelial cells. We suggest that these mechanisms contribute to pulmonary selectivity of this toxic injury model of pulmonary hypertension.

Interaction of H2O, O2 and H2 with Proton Conducting Oxides Based on Lanthanum Scandates

2019 ◽  
pp. 88-100
Author(s):  
A. S. Farlenkov ◽  
N. A. Zhuravlev ◽  
Т. A. Denisova ◽  
М. V. Ananyev
Keyword(s):  
Water Vapor ◽  
Partial Pressure ◽  
Gas Phase ◽  
Molecular Hydrogen ◽  
Proton Magnetic Resonance ◽  
Partial Pressure Of Oxygen ◽  
Proton Conducting ◽  
Conducting Oxides ◽  
Temperature Range ◽  
Apparent Level

The research uses the method of high-temperature thermogravimetric analysis to study the processes of interaction of the gas phase in the temperature range 300–950 °C in the partial pressure ranges of oxygen 8.1–50.7 kPa, water 6.1–24.3 kPa and hydrogen 4.1 kPa with La1–xSrxScO3–α oxides (x = 0; 0.04; 0.09). In the case of an increase in the partial pressure of water vapor at a constant partial pressure of oxygen (or hydrogen) in the gas phase, the apparent level of saturation of protons is shown to increase. An increase in the apparent level of saturation of protons of the sample also occurs with an increase in the partial pressure of oxygen at a constant partial pressure of water vapor in the gas phase. The paper discusses the causes of the observed processes. The research uses the hydrogen isotope exchange method with the equilibration of the isotope composition of the gas phase to study the incorporation of hydrogen into the structure of proton-conducting oxides based on strontium-doped lanthanum scandates. The concentrations of protons and deuterons were determined in the temperature range of 300–800 °C and a hydrogen pressure of 0.2 kPa for La0.91Sr0.09ScO3–α oxide. The paper discusses the role of oxygen vacancies in the process of incorporation of protons and deuterons from the atmosphere of molecular hydrogen into the structure of the proton conducting oxides La1–xSrxScO3–α (x = 0; 0.04; 0.09). The proton magnetic resonance method was used to study the local structure in the temperature range 23–110 °C at a rotation speed of 10 kHz (MAS) for La0.96Sr0.04ScO3–α oxide after thermogravimetric measurements in an atmosphere containing water vapor, and after exposures in molecular hydrogen atmosphere. The existence of proton defects incorporated into the volume of the investigated proton oxide from both the atmosphere containing water and the atmosphere containing molecular hydrogen is unambiguously shown. The paper considers the effect of the contributions of the volume and surface of La0.96Sr0.04ScO3–α oxide on the shape of the proton magnetic resonance spectra.

Sign in / Sign up

Export Citation Format

Share Document