Prophylactic pharyngeal surfactant with simultaneous sustained inflation in prematures < 25 weeks of gestation

The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted.

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Ventilatory responses to CO2 and lung inflation in tonic versus phasic REM sleep

Journal of Applied Physiology ◽

10.1152/jappl.1979.47.6.1304 ◽

1979 ◽

Vol 47 (6) ◽

pp. 1304-1310 ◽

Cited By ~ 38

Author(s):

C. E. Sullivan ◽

E. Murphy ◽

L. F. Kozar ◽

E. A. Phillipson

Keyword(s):

Eye Movements ◽

Rem Sleep ◽

Slow Wave Sleep ◽

Minute Volume ◽

Sleep State ◽

Lung Inflation ◽

Ventilatory Responses ◽

Sustained Inflation ◽

Per Se ◽

Phasic Rem Sleep

Ventilatory responses to CO2 and to lung inflation were compared in four dogs during tonic and phasic segments of rapid-eye-movement (REM) sleep. Phasic REM sleep (P-REM) was identified by the presence of bursts of rapid eye movements, visible muscle twitchings, and frequent phasic discharges in the nuchal electromyogram. These features were absent during tonic REM sleep (T-REM). During P-REM the response of minute volume of ventilation (VI) to progressive hypercapnia (0.58 +/- 0.19 (l/min)/Torr, mean +/- SE) was significantly less than in slow-wave sleep (SWS) (1.40 +/- 0.14; P less than 0.05). In contrast, during T-REM the response (1.48 +/- 0.19) was similar to that in SWS. Similarly, during P-REM the duration of apnea (5.9 +/- 1.5 s) elicited by sustained inflation of the lungs with 1.0 liter of air, was significantly shorter than in SWS (25.8 +/- 0.8); in contrast, during T-REM the duration of apnea (17.8 +/- 3.6) was similar to that in SWS. The results indicate that previously described decreases in VI responses to CO2 and apneic responses to lung inflation during P-REM, compared to SWS, are related to the phasic phenomena of REM sleep, rather than to the REM sleep state per se.

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The SURV1VE trial—sustained inflation and chest compression versus 3:1 chest compression-to-ventilation ratio during cardiopulmonary resuscitation of asphyxiated newborns: study protocol for a cluster randomized controlled trial

Trials ◽

10.1186/s13063-019-3240-8 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Georg M. Schmölzer ◽

◽

Gerhard Pichler ◽

Anne Lee Solevåg ◽

Caroline Fray ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Study Protocol ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Randomized Controlled ◽

Sustained Inflation ◽

Cluster Randomized

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Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions

Frontiers in Pediatrics ◽

10.3389/fped.2020.602228 ◽

2020 ◽

Vol 8 ◽

Author(s):

Seung Yeon Kim ◽

Gyu-Hong Shim ◽

Megan O'Reilly ◽

Po-Yin Cheung ◽

Tze-Fun Lee ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Cerebral Oxygenation ◽

Secondary Analysis ◽

Spontaneous Circulation ◽

Male And Female ◽

Newborn Piglets ◽

Sustained Inflation ◽

Significant Difference ◽

Tissue Homogenates ◽

Males And Females

Background: Male newborns have a greater risk of poor cardiovascular and respiratory outcomes compared to females. The mechanisms associated with the “male disadvantage” remains unclear. We have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery. However, it is unknown if there are differences in resuscitation outcomes between males and females during different cardiopulmonary resuscitation techniques.Intervention and Measurements: Secondary analysis of 184 term newborn mixed breed duroc piglets (1–3 days of age, weighing 2.0 (0.2) kg) from seven different studies, which were exposed to 30–50 min of normocapnic hypoxia followed by asphyxia until asystole. This was followed by cardiopulmonary resuscitation. For the analysis, piglets were divided into male and female groups, as well as resuscitation technique groups (sustained inflation, 3:1 compression-to-ventilation ratio, or asynchronous ventilations during chest compressions). Cardiac function, carotid blood flow, and cerebral oxygenation were continuously recorded throughout the experiment.Main results: Regardless of resuscitation technique, there was no significant difference between males and females in the number achieving return of spontaneous circulation (ROSC) [95/123 (77%) vs. 48/61 (79%)], the time to achieve ROSC [112 (80–185) s vs. 110 (77–186) s], and the 4-h survival rate [81/95 (85%) vs. 40/48 (83%)]. Levels of the injury markers interleukin (IL)−1ß, IL-6, IL-8, and tumor necrosis factor-α in frontoparietal cortex tissue homogenates were similar between males and females.Conclusions: Regardless of resuscitation technique, there was no significant effect of sex on resuscitation outcome, survival, and hemodynamic recovery in asphyxiated newborn piglets.

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Sustained Inflation for Lung Aeration After Birth

NeoReviews ◽

10.1542/neo.17-1-e8 ◽

2016 ◽

Vol 17 (1) ◽

pp. e8-e17 ◽

Cited By ~ 1

Author(s):

E. E. Foglia ◽

H. Kirpalani

Keyword(s):

Lung Aeration ◽

Sustained Inflation

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Chest Compressions in the Delivery Room

Children ◽

10.3390/children6010004 ◽

2019 ◽

Vol 6 (1) ◽

pp. 4 ◽

Cited By ~ 3

Author(s):

Catalina Garcia-Hidalgo ◽

Georg M. Schmölzer

Keyword(s):

Cardiopulmonary Resuscitation ◽

Chest Compression ◽

Mode Of Action ◽

Poor Prognosis ◽

Delivery Room ◽

Chest Compressions ◽

Optimal Depth ◽

The Poor ◽

Sustained Inflation ◽

High Incidence

Annually, an estimated 13–26 million newborns need respiratory support and 2–3 million newborns need extensive resuscitation, defined as chest compression and 100% oxygen with or without epinephrine in the delivery room. Despite such care, there is a high incidence of mortality and neurologic morbidity. The poor prognosis associated with receiving chest compression alone or with medications in the delivery room raises questions as to whether improved cardiopulmonary resuscitation methods specifically tailored to the newborn could improve outcomes. This review discusses the current recommendations, mode of action, different compression to ventilation ratios, continuous chest compression with asynchronous ventilations, chest compression and sustained inflation optimal depth, and oxygen concentration during cardiopulmonary resuscitation.

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