Objective: To evaluate how different ways of handling the neonatal self-inflating bag influence peak pressure and tidal volume.Methods: This is an experimental study involving 141 different professionals (physicians, resident physicians, physiotherapists, nurses, and nursing technicians), who ventilated an artificial lung, adjusted to simulate the lung of a term neonate, using a self-inflating bag. Each professional handled the ventilator in five different ways: a) using both hands (10 fingers); and, with only one hand, b) five fingers, c) four fingers, d) three fingers, and e) two fingers. Peak pressure and tidal volume data were recorded by the artificial lung equipment.Results: Both variables showed high variability, from 2.5 to 106.3 cmH 2 O (mean = 39.73 cmH 2 O; 95%CI 37.32-42.13) for peak pressure, and from to 4 to 88 mL (mean = 39.56 mL; 95%CI 36.86-42.25) for tidal volume. There was no significant influence of the profession on any of the variables (p > 0.05). However, bag handling significantly influenced both peak pressure and tidal volume (p < 0.0001), which were higher when the operator used both hands. Conclusion:The results indicate that most professionals delivered excessively high peak pressures and tidal volumes, which could increase the risk of barotrauma and volutrauma, especially when both hands were used to ventilate. On the other hand, a small number of professionals delivered insufficient pressure and volume for adequate lung expansion and ventilation. The delivery of inadequate ventilation was not dependent on profession. J Pediatr (Rio J). 2009;85(3):217-222:Neonatal resuscitation, manual lung ventilation, self-inflating bags, barotrauma. ResumoObjetivo: Avaliar a influência do manuseio do ventilador pulmonar manual neonatal com bolsa autoinflável sobre pico de pressão e volume corrente.Métodos: Estudo experimental com 141 profissionais de saúde (médicos, médicos residentes, fisioterapeutas, enfermeiros e técnicos de enfermagem) que ventilaram um pulmão artificial ajustado para reproduzir o pulmão de um recém-nascido a termo, utilizando ventilador pulmonar manual autoinflável com cinco diferentes modos de manuseio: com as duas mãos (10 dedos) e com uma mão, utilizando cinco, quatro, três e dois dedos. Valores de pico de pressão e volume corrente foram registrados pelo pulmão artificial.Resultados: Observou-se alta variabilidade nos valores das variáveis estudadas. A média do pico de pressão foi 39,73 cmH 2 O (IC95% 37,32-42,13), variando de 2,5 a 106,3 cmH 2 O, e do volume foi 39,56 mL (IC95% 36,86-42,25), variando de 4 a 88 mL. Não foi detectada influência significativa da profissão sobre as variáveis estudadas (p > 0,05). Observou-se que o modo de manuseio do ventilador pulmonar manual influenciou significativamente o pico de pressão e o volume corrente (p < 0,0001), que foram maiores quando o ventilador foi manuseado com as duas mãos. Conclusão:A maioria dos profissionais gerou pico de pressão e volume corrente muito elevados, principalmente quando foram empregadas as duas mã...

We saw a 34-year-old pregnant woman with acute promyelocytic leukemia, who developed acute respiratory failure from all-trans-retinoic acid (ATRA) syndrome. We applied noninvasive ventilation (NIV, continuous positive airway pressure plus pressure-support ventilation) to try to improve gas exchange, reduce the work of breathing, and prevent intubation. Initially we applied NIV continuously (24 hours a day), then gradually reduced the daily amount of time on NIV as her condition improved. She was discharged from the intensive care unit after 12 days. Three months after hospital discharge she gave vaginal birth to a healthy female baby. NIV was effective and safe for the mother and fetus, and NIV should be considered for respiratory failure in pregnant patients, especially if immunosuppressed.

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The present case series is the first to report the use of the MLD and MCT in the successful management of female genital edema. This report suggests that the vulvar edemas for these four patients treated with MLD and MCT seem to resolve faster than expected based on previously reported untreated edemas or edemas treated with different therapeutic approaches.