We feel that neurally adjusted ventilatory assist would be safe and potentially efficacious to ventilate infants and children. It has the potential for improved patient-ventilator synchrony, decreasing airway pressures, and it might lead to earlier extubation.

We have studied the effects on lung volume, respiratory mechanics and ventilation during the first hours after instillation of 60 mg/kg of human surfactant into the trachea of 4 very preterm, newborn infants with severe IRDS under mechanical ventilation. Measurements were made with a "face-out" body plethysmograph and a modified nitrogen wash-out method. In addition to a transient decrease in total and alveolar ventilation immediately after the instillation we found an immediate rise in lung volume, but respiratory compliance decreased. These changes lasted less than two hours. Oxygen requirements fell in 3 out of 4 infants. The changes in lung volume and compliance are explained in terms of changes in the shape of the static recoil pressure characteristics of the diseased lungs after treatment. Mechanisms behind the short duration are sought in mode of instillation, dosage, age at treatment, and severity of disease.

ObjectiveFactors predicting survival over time after pediatric intensive care unit (PICU) admissions are not fully understood. The primary aim of the current study was to investigate whether multiple admissions (MADM) compared to single PICU admissions (SADM) were associated with poor survival over time after being admitted to PICU facilities. Our secondary aim was to investigate if the presence of a complex chronic condition (CCC) would further impair prognosis.DesignA closed cohort of all children up to 16 years of age admitted to the three PICUs in Sweden between 2008 and 2010 was prospectively collected and followed until 2012, providing survival data for at least one but up to four years of follow-up.SettingThree Swedish tertiary referral centers for pediatric intensive care and extracorporeal membrane oxygenation (ECMO) care were used.PatientsIn total, 3,688 Swedish children with 5,019 PICU admissions were included.InterventionsNo interventions were conducted.MeasurementsAn extensive data set was recorded, including up to four-year survival information following first PICU admission. The patients were assigned to seven admission diagnostic groups, which were then divided into SADM or MADM groups. The difference in survival over time and mortality rates (MR) and mortality rate ratios (MRR) were calculated. SADM and MADM groups with and without an existing CCC were formed. The difference in survival over time between groups was calculated.Main resultsA highly significant difference in survival over time was noted between SADM and MADM patients (p<0.0001), which was intensified by the presence of a CCC. MADM patients with a CCC had the worst outcome, while SADM patients without a CCC had the best outcome. MADM patients with no CCC demonstrated decreased survival over time compared to SADM patients with a CCC. Survival over time was statistically worsened for patients with MADM compared to SADM for the following admission diagnostic groups: Cardiovascular, Gastrointestinal/Renal, Respiratory, Neurological, and Miscellaneous. The mortality rate (deaths/patient year of follow-up) during the time of follow-up was 0.023 for SADM and 0.062 for MADM patients. The mortality rate ratio (MRR) between these groups was 2.69.ConclusionCompared to single admissions, multiple admissions to PICU were associated with a significant decrease in survival over time in some but not all diagnostic groups. Regarding our secondary aim, we found that when the presence of a CCC is factored into the survival analysis, survival over time is further impaired.

ABSTRACT. We assessed pulmonary function in 14 mechanically ventilated newborn very low birth weight infants with idiopathic respiratory distress syndrome by means of a face-out, volume displacement body plethysmograph and nitrogen washout analyses. Specially designed computer programs were used for calculations of lung volumes, ventilation, gas mixing efficiency, and mechanical parameters. In addition to very low compliance and moderately elevated resistance of the respiratory system, there were considerably impaired gas mixing efficiency and low functional residual capacity (FRC) For methodologic reasons, lung function studies in newborn infants with IRDS have largely been focused on lung mechanics. Using applied methods makes it possible to obtain a more comprehensive picture of ventilatory conditions, even in very premature, severely affected infants. To further clarify the pathophysiology of IRDS under conditions of mechanical ventilation in this group of infants, we assessed lung volume, alveolar ventilation, gas mixing efficiency, and lung mechanics in mechanically ventilated infants with birth weights below 1500 g. MATERIALS AND METHODSWe studied 14 very low birth weight infants with IRDS during intermittent positive pressure ventilation within 5 d (range 0-5 d) of birth. Six of the infants were boys and eight were girls. Median birth weight was 1.29 kg (range 1.00-1.50 kg) and median gestational age was 29 wk (range 26-33 wk). Informed consent was obtained from the parents of each infant before the procedure was camed out, and the study was approved by the ethics committee of Goteborg University.Maternal history included preeclampsia in six cases and abruption of the placenta in three cases. One infant was a twin. Twelve infants were delivered by cesarean section. Apgar scores were below 5 at 1 min in seven infants and below 7 at 5 min in seven infants. All infants were flushed with oxygen immediately after birth, and nine were also ventilated using a mask. Ten of the infants with adequate spontaneous respiration were treated with continuous positive airway pressure by nasal prongs within 4 h of birth, and the other four were intubated and ventilated within a few minutes of birth. Mechanical ventilation was started within 27 h in all infants. The pulmonary disease was classified as IRDS in all infants (1). All initial radiographs showed a reticulogranular pattern, and no infant had positive blood cultures or hematologic signs of infection.The following guidelines for mechanical ventilation of very low birth weight infants with IRDS were used in the intensive care unit: Nasal intubation with uncuffed endotracheal tubes 2.5-3.0 (Portex LTD, Hythe, Kent, UK) was performed. A Sechrist Infant Ventilator 400 B (Sechrist Industries Inc., Anaheim, CA) was connected to the endotracheal tube. The breathing gas was humidified and heated with a humidifier (Fisher and Paykel, Auckland, New Zealand). Initial ventilator settings were: respiratory rate 60 breathslmin, inspiratory/expiratory ratio 112, PIP 25-30 cm H20,...

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