scholarly journals Pulmonary air leak syndrome in term and late preterm neonates

2019 ◽  
Vol 147 (9-10) ◽  
pp. 578-582
Author(s):  
Gordana Markovic-Sovtic ◽  
Tatjana Nikolic ◽  
Aleksandar Sovtic ◽  
Jelena Martic ◽  
Zorica Rakonjac
Keyword(s):  
Mechanical Ventilation ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Late Preterm ◽  
Respiratory Support ◽  
Medical Emergency ◽  
Preterm Neonates ◽  
Air Leak ◽  
Average Birth Weight ◽  
Air Leak Syndrome

Introduction/Objective. Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods. Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results. Eighty-seven neonates of an average gestational age 38.1 ? 1.9 g.w. were included in the study. The average birth weight was 3182.5 ? 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion. Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group.

scholarly journals Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1035
Author(s):  
Rachel K. Marlow ◽  
Sydney Brouillette ◽  
Vannessa Williams ◽  
Ariann Lenihan ◽  
Nichole Nemec ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Respiratory Support ◽  
Non Invasive ◽  
Lengths Of Stay

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections.

Ventilator trauma in the critically ill

2016 ◽  
Author(s):  
Marcelo Amato ◽  
Andreas Wolfgang Reske
Keyword(s):  
Mechanical Ventilation ◽  
Inflammatory Responses ◽  
Transpulmonary Pressure ◽  
Stress And Strain ◽  
Air Leak ◽  
Mechanically Ventilated ◽  
Ventilator Induced Lung Injury ◽  
Acute Form ◽  
Air Leak Syndrome ◽  
Definition Of

Ventilator trauma refers to complications of mechanical ventilation, which have an impact on morbidity and mortality. Two major forms of ventilator trauma may be distinguished—an acute form related to rupture of airspaces causing air-leak syndrome and a subacute form causing protracted inflammatory responses. A key feature of mechanically-ventilated lungs is the presence of non-aerated and unstable regions due to atelectasis, oedema, or consolidation. Because of mechanical interdependence, pressures acting in non-uniformly expanded lungs at the boundaries between non-aerated and aerated lung may be a multiple of the apparent transpulmonary pressure. The resulting effects have been reported to precipitate or contribute to ventilator-induced lung injury (VILI). The engineering terms stress and strain were recently proposed for better definition of risk-constellations for VILI. Because the aerated lung volume is positively correlated to compliance, driving-pressure can aid in identifying disproportionate combinations of tidal volumes and compliance.

scholarly journals Short Term Outcome of Preterm Neonates Required Mechanical Ventilation

2017 ◽  
Vol 15 (2) ◽  
pp. 9-13
Author(s):  
Md Abdul Mannan ◽  
Nasim Jahan ◽  
Shahed Iqbal ◽  
Navila Ferdous ◽  
Subir Dey ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Perinatal Asphyxia ◽  
Surfactant Therapy ◽  
Western World ◽  
Preterm Neonates ◽  
Preterm Baby ◽  
Term Outcome ◽  
Ventilator Support ◽  
Mechanically Ventilated ◽  
Neonatal Ventilation

Background: Since its inception, the neonatal mechanical ventilator has been considered an essential tool for managing preterm neonates with Respiratory Distress Syndrome (RDS) and is still regarded as an integral component in the neonatal respiratory care continuum. Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the western world and neighboring countries, neonatal ventilation in our country is still in its infancy. To analyze the common indications and outcome of preterm neonates required mechanical ventilation.Methods: This was a retrospective observational study conducted on preterm neonates required mechanical ventilation over a period of 12 months (July 2013 to June 2014).Results: A total of 50 neonates were mechanically ventilated during the study period of which 68% (n=34) survived. The survival rate was higher (77%) in 34- <37 weeks Gestational Age (GA) group and gradually declined in 30- <34 weeks (71%) & 27- <30 weeks (56%) GA. The neonates with Birth Weight (BW) ? 2500gm were higher survivals which was 100% and lower in 1500-2499gm (81%), 1000-1499gm (68%) and 800-999gm (33%) BW groups. Inborn neonates (68%) showed marginally higher survivals than outborn (66%) and also more survivals observed in preterm baby girls (72%) than boys (65%). RDS (62%) was the commonest indication for ventilation followed by Neonatal Sepsis (14%), Perinatal Asphyxia (PNA-10%), Congenital Pneumonia (8%) and Pneumothorax (6%). And found higher survivals in RDS (77%) than other indications which were in Pneumothorax (66%), PNA (60%), Sepsis (57%) and Pneumonia (50%). RDS (n=31) with surfactant therapy (n=14) recovered earlier <7 days (71.43%) than non surfactant therapy neonates (n=17), they required prolonged ventilator support over 7days (82.35%).Conclusions: Mechanical ventilation reduces the neonatal mortality, hence facilities for neonatal ventilation should be included in the regional and central hospitals providing intensive care for neonates.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 9-13

Lost in Transition: Is Early Respiratory Support in Newborn Infants the Best Option?

Neonatology ◽  
2020 ◽  
Vol 117 (4) ◽  
pp. 517-521
Author(s):  
Adam Buckmaster ◽  
Gaston Arnolda ◽  
Louise Owen ◽  
Calum Roberts ◽  
Peter Davis ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Treatment Failure ◽  
Newborn Infants ◽  
Supplemental Oxygen ◽  
Late Preterm ◽  
Respiratory Support ◽  
Severe Illness ◽  
Intravenous Fluids ◽  
Using Data

<b><i>Background:</i></b> Late preterm and term newborns with respiratory distress are increasingly treated with non-invasive ventilation (NIV) including nasal high-flow or continuous positive airway pressure. For infants with mild distress, NIV may be unnecessary. <b><i>Objectives:</i></b> We speculated that treatment with supplemental oxygen (SO) prior to NIV could help clinicians select infants for NIV treatment, and examined this hypothesis using data from a recently completed trial. <b><i>Method:</i></b> Post hoc analysis of data from a subset of infants enrolled in the HUNTER trial. Infants born at ≥36 weeks’ gestation were categorized by whether they were receiving SO prior to randomization. The 2 groups were compared for illness severity (indicated by treatment failure at 72 h, mechanical ventilation, need for up-transfer, SO requirement post-randomization, and length of time receiving respiratory support), use of selected medical interventions (antibiotics, intravenous fluids), and breastfeeding at discharge. <b><i>Results:</i></b> Analysis included 380 infants. Infants not receiving SO had less severe illness; lower rates of treatment failure (7.3 vs. 17.2%), mechanical ventilation (0.6 vs. 5.9%), need for transfer (6.8 vs. 13.8%), and more often did not receive any SO post-randomization (75.1 vs. 3.0%). Most infants in both groups received intravenous fluids (93 and 98%) and antibiotics (81 and 93%); the rate of full breastfeeding was low in both groups (51 and 45%). <b><i>Conclusions:</i></b> Late preterm and term newborn infants without SO requirement at the time of commencing NIV for respiratory distress are at lower risk of requiring treatment escalation. Close observation of these infants (watch and wait strategy) may avoid unnecessary treatment.

scholarly journals Antenatal corticosteroids for impending late preterm (34-36+6 weeks) deliveries—A systematic review and meta-analysis of RCTs

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248774
Author(s):  
Mangesh Deshmukh ◽  
Sanjay Patole
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Neonatal Resuscitation ◽  
Late Preterm ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Antenatal Corticosteroids ◽  
Neurodevelopmental Outcomes ◽  
Level Of Evidence

Background Administration of antenatal corticosteroids (ANC) for impending preterm delivery beyond 34 weeks of gestation continues to be a controversial issue despite various guidelines for obstetricians and gynaecologists. Objective To compare outcomes following exposure to ANC for infants born between 34–36+6 weeks’ gestation. Methods A systematic review of randomised controlled trials (RCT) reporting neonatal outcomes after ANC exposure between 34–36+6 weeks’ gestation using Cochrane methodology. Databases including PubMed, Embase, Emcare, Cochrane Central library and Google Scholar were searched in May 2020. Primary outcomes: (1) Need for respiratory support (Mechanical ventilation, CPAP, high flow) or oxygen (2) Hypoglycemia. Secondary outcomes included respiratory distress syndrome (RDS), transient tachypnoea of newborn (TTN), need for neonatal resuscitation at birth [only in the delivery room immediately after birth (not in neonatal intensive care unit (NICU)], admission to NICU, mortality and developmental follow up. Level of evidence (LOE) was summarised by GRADE guidelines. Main results Seven RCTs (N = 4144) with low to high risk of bias were included. Only one RCT was from high income countries, Meta-analysis (random-effects model) showed (1) reduced need for respiratory support [5 RCTs (N = 3844); RR = 0.68 (0.47–0.98), p = 0.04; I2 = 55%; LOE: Moderate] and (2) higher risk of neonatal hypoglycaemia [4 RCTs (N = 3604); RR = 1.61(1.38–1.87), p<0.00001; I2 = 0%; LOE: High] after ANC exposure. Neonates exposed to ANC had reduced need for resuscitation at birth. The incidence of RDS, TTN and surfactant therapy did not differ significantly. None of the included studies reported long-term developmental follow up. Conclusions Moderate quality evidence indicates that ANC exposure reduced need for respiratory support, and increased the risk of hypoglycaemia in late preterm neonates. Large definitive trials with adequate follow up for neurodevelopmental outcomes are required to assess benefits and risks of ANC in this population.

A case of significant subcutaneous emphysema on non-invasive respiratory support in a late preterm infant

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Satyaranjan Pegu ◽  
Jaya P. Bodani ◽  
Bakul Deb
Keyword(s):  
Mechanical Ventilation ◽  
Subcutaneous Emphysema ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Late Preterm ◽  
Respiratory Support ◽  
Late Preterm Infant ◽  
Preterm Baby ◽  
Non Invasive ◽  
Premature Babies

Abstract Air leaks are known complications associated with mechanical ventilation, with a higher incidence in more premature babies. Pneumothorax and pneumomediastinum are the most common ones and the majority would resolve spontaneously without active intervention. Subcutaneous emphysema is very rare, with few reported cases in neonates. We report here a case of extensive subcutaneous emphysema, pneumothorax and pneumomediastinum in a late preterm baby developed while on nasal continuous positive airway pressure (nCPAP) respiratory support.

scholarly journals The effects of betamethasone on clinical outcome of the late preterm neonates born between 34 and 36 weeks of gestation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yas Arimi ◽  
Narges Zamani ◽  
Mamak Shariat ◽  
Hossein Dalili
Keyword(s):  
Preterm Infants ◽  
Adverse Outcomes ◽  
Late Preterm ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Control Group ◽  
Corticosteroid Administration ◽  
Late Preterm Infants ◽  
Beneficial Effects ◽  
Lung Maturity

Abstract Background Prenatal corticosteroid administration in preterm labor is one of the most important treatments available to improve neonatal outcomes; however, its beneficial effects on late preterm infants (after the 34th week of gestation) remained unknown. We aimed to assess the effects of betamethasone on the clinical condition of the late preterm infants born between 34 and 36 weeks of gestation. Methods This retrospective cohort study was performed on 100 consecutive infants born between 34 and 36 weeks of gestation and received betamethasone before delivery as the cases and 100 neonates with the same delivery conditions but without receiving betamethasone. All neonates were followed up within hospitalization to assess the neonatal outcome. Results The neonates receiving betamethasone suffered more from respiratory distress syndrome (49% versus 31%, p = 0.008, RR = 1.59 95% CI (1.12–2.27)) and requiring more respiratory support (71% versus 50%, p = 0.002, RR = 1.43 95% CI (1.13–1.80)) as compared to the control group. There was no difference between the two groups in other neonatal adverse events or death. Conclusion the use of betamethasone in the late preterm period (after 34 weeks of gestation) has no beneficial effects on lung maturity or preventing neonatal adverse outcomes, even may lead to increase the risk for RDS and requiring respiratory support.

scholarly journals The effects of betamethasone on clinical outcome of the late preterm neonates born between 34 and 36 weeks of gestation

2021 ◽  
Author(s):  
Yas Arimi ◽  
Narges Zamani ◽  
Mamak Shariat ◽  
Hossein Dalili
Keyword(s):  
Preterm Infants ◽  
Adverse Outcomes ◽  
Late Preterm ◽  
Respiratory Support ◽  
Preterm Neonates ◽  
Control Group ◽  
Corticosteroid Administration ◽  
Late Preterm Infants ◽  
Beneficial Effects ◽  
Lung Maturity

Abstract Background: Prenatal corticosteroid administration in preterm labor is one of the most important treatments available to improve neonatal outcomes; however its beneficial effects on late preterm infants (after the 34th week of gestation) remained unknown. We aimed to assess the effects of betamethasone on the clinical condition of the late preterm infants born between 34 and 36 weeks of gestation. Methods: This retrospective cohort study was performed on 100 consecutive infants born between 34 and 36 weeks of gestation and received betamethasone before delivery as the cases and 100 neonates with the same delivery conditions but without receiving betamethasone. All neonates were followed up within hospitalization to assess the neonatal outcome. Results: The neonates receiving betamethasone suffered more from respiratory distress syndrome (49% versus 31%, p = 0.008) and requiring more respiratory support (71% versus 50%, p = 0.002) as compared to the control group. There was no difference between the two groups in other neonatal adverse events or death. Conclusion: the use of betamethasone in the late preterm period (after 34 weeks of gestation) has no beneficial effects on lung maturity or preventing neonatal adverse outcomes, even may lead to increase the risk for RDS and requiring respiratory support.

scholarly journals Non-invasive High-Frequency Oscillatory Ventilation as Initial Respiratory Support for Preterm Infants With Respiratory Distress Syndrome

2022 ◽  
Vol 9 ◽  
Author(s):  
Shu-Hua Lai ◽  
Ying-Ling Xie ◽  
Zhi-Qin Chen ◽  
Rong Chen ◽  
Wen-Hong Cai ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Distress Syndrome ◽  
Length Of Hospital Stay ◽  
Supplemental Oxygen ◽  
Respiratory Support ◽  
Air Leak ◽  
Non Invasive ◽  
Air Leak Syndrome ◽  
Respiratory Outcomes ◽  
High Frequency Oscillatory

Objectives: The aim of this study was to investigate the safety and feasibility of nHFOV as initial respiratory support in preterm infants with RDS.Methods: This study retrospectively analyzed the clinical data of 244 premature infants with RDS who were treated in our hospital from January 2016 to January 2019 and divided into the nHFOV group (n = 115) and the BiPAP group (n = 129) based on the initial respiratory support method.Results: Respiratory outcomes showed that the rate of NIV failure during the first 72 hours of life in the nHFOV group was significantly lower than that in the BiPAP group. The time of NIV in the nHFOV group was significantly shorter than that in the BiPAP group. The time of supplemental oxygen in the nHFOV group was significantly shorter than that in the BiPAP group. The incidence of air leakage syndrome in the nHFOV group was significantly lower than that in the BiPAP group, and the length of hospital stay of the nHFOV group was also significantly shorter than that in the BiPAP group. Although the rate of infants diagnosed with BPD was similar between the two groups, the rate of severe BPD in the nHFOV group was significantly lower than that in the BiPAP group.Conclusion: This study showed that nHFOV as initial respiratory support for preterm infants with RDS was feasible and safe compared to BiPAP. Furthermore, nHFOV can reduce the need for IMV and reduce the incidence of severe BPD and air leak syndrome.

Air leak with COVID-19 – A meta-summary

2021 ◽  
pp. 021849232110311
Author(s):  
Prashant Nasa ◽  
Deven Juneja ◽  
Ravi Jain
Keyword(s):  
Respiratory Disease ◽  
Positive Pressure Ventilation ◽  
Case Reports ◽  
Final Analysis ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Air Leak ◽  
Air Leaks ◽  
Air Leak Syndrome ◽  
The Individual

Introduction There are various reports of air leaks with coronavirus disease 2019 (COVID-19). We undertook a systematic review of all published case reports and series to analyse the types of air leaks in COVID-19 and their outcomes. Methods The literature search from PubMed, Science Direct, and Google Scholar databases was performed from the start of the pandemic till 31 March 2021. The inclusion criteria were case reports or series on (1) laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, (2) with the individual patient details, and (3) reported diagnosis of one or more air leak syndrome (pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, pneumopericardium). Results A total of 105 studies with 188 patients were included in the final analysis. The median age was 56.02 (SD 15.53) years, 80% males, 11% had previous respiratory disease, and 8% were smokers. Severe or critical COVID-19 was present in 50.6% of the patients. Pneumothorax (68%) was the most common type of air leak. Most patients (56.7%) required intervention with lower mortality (29.1% vs. 44.1%, p = 0.07) and intercostal drain (95.9%) was the preferred interventional management. More than half of the patients developed air leak on spontaneous breathing. The mortality was significantly higher in patients who developed air leak with positive pressure ventilation (49%, p < 0.001) and required escalation of respiratory support (39%, p = 0.006). Conclusion Air leak in COVID-19 can occur spontaneously without positive pressure ventilation, higher transpulmonary pressures, and other risk factors like previous respiratory disease or smoking. The mortality is significantly higher if associated with positive pressure ventilation and escalation of respiratory support.

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