Effect of inspired gas temperature on lung mechanics and gas exchange in neonates in normothermia or therapeutic hypothermia

Regiroli, Giulia; Loi, Barbara; Fortas, Feriel; Centorrino, Roberta; Mosca, Fabio; Luca, Danièle De

doi:10.1016/j.resuscitation.2021.04.015

Cited by 3 publications

(2 citation statements)

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“…Our study presents new insights into lung mechanics during TH. Experimental and clinical reports suggest that ventilatory mechanics depends closely on changes in body temperature ( 35 , 36 ). Although deep hypothermia resulted in decreased pulmonary compliance in anesthetized ventilated lambs ( 35 ), mild hypothermia had no similar effects in ventilated adult patients after cardiac arrest ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Expiratory braking defines the breathing patterns of asphyxiated neonates during therapeutic hypothermia

Papoff,

Caresta,

D’Agostino

et al. 2024

Front. Pediatr.

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IntroductionAlthough neonatal breathing patterns vary after perinatal asphyxia, whether they change during therapeutic hypothermia (TH) remains unclear. We characterized breathing patterns in infants during TH for hypoxic-ischemic encephalopathy (HIE) and normothermia after rewarming.MethodsIn seventeen spontaneously breathing infants receiving TH for HIE and in three who did not receive TH, we analyzed respiratory flow and esophageal pressure tracings for respiratory timing variables, pulmonary mechanics and respiratory effort. Breaths were classified as braked (inspiratory:expiratory ratio ≥1.5) and unbraked (<1.5).ResultsAccording to the expiratory flow shape braked breaths were chategorized into early peak expiratory flow, late peak expiratory flow, slow flow, and post-inspiratory hold flow (PiHF). The most braked breaths had lower rates, larger tidal volume but lower minute ventilation, inspiratory airway resistance and respiratory effort, except for the PiHF, which had higher resistance and respiratory effort. The braked pattern predominated during TH, but not during normothermia or in the uncooled infants.ConclusionsWe speculate that during TH for HIE low respiratory rates favor neonatal braked breathing to preserve lung volume. Given the generally low respiratory effort, it seems reasonable to leave spontaneous breathing unassisted. However, if the PiHF pattern predominates, ventilatory support may be required.

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Section: Discussionmentioning

confidence: 99%

Expiratory braking defines the breathing patterns of asphyxiated neonates during therapeutic hypothermia

Papoff,

Caresta,

D’Agostino

et al. 2024

Front. Pediatr.

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“…Patients were monitored using pre- and postductal oxyhemoglobin saturations, perfusion index, aEEG, end-tidal or transcutaneous CO 2 monitoring (in conventional or high-frequency ventilation, respectively), and invasive arterial pressure, as well as cerebral and renal near-infrared spectroscopies (10). Oxygenation metrics were calculated from blood gas analyses using blood from indwelling umbilical or peripheral arterial lines; for neonates subjected to whole body hypothermia, blood gases were corrected for the core body temperature using pH-state (16). Point-of-care lung, cardiac, and cerebral ultrasounds were carried out every 8 hours (15).…”

Section: Methodsmentioning

confidence: 99%

Continuous Venovenous Hemofiltration Performed by Neonatologists With Cardio-Renal Pediatric Dialysis Emergency Machine to Treat Fluid Overload During Multiple Organ Dysfunction Syndrome: A Case Series

Regiroli

Loi

Pezza

et al. 2023

Pediatric Critical Care Medicine

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A new device is available for neonates needing extracorporeal renal replacement therapy. We reviewed the use of this device (in continuous venovenous hemofiltration [CVVH] mode) in term or preterm neonates affected by multiple organ dysfunction syndrome (MODS) with fluid overload. DESIGN: Case series. SETTING: Academic specialized referral neonatal ICU (NICU) with expertise on advanced life support and monitoring. PATIENTS: Neonates with MODS and fluid overload despite conventional treatments and receiving at least one CVVH session. INTERVENTION: CVVH with the Cardio-Renal Pediatric Dialysis Emergency Machine. MEASUREMENTS AND MAIN RESULTS:Ten (three preterm) neonates were treated using 18 consecutive CVVH sessions. All patients were in life-threatening conditions and successfully completed the CVVH treatments, which almost always lasted 24 hr/session, without major side effects. Three neonates survived and were successfully discharged from hospital with normal follow-up. CVVH reduced fluid overload (before versus after represented as a weight percentage: 23.5% [12-34%] vs 14.6% [8.2-24.1%]; p = 0.006) and lactate (before versus after: 4.6 [2.9-12.1] vs 2.9 mmol/L [2.3-5.5 mmol/L]; p = 0.001). CVVH also improved the Pao 2 to Fio 2 (before vs after: 188 mm Hg [118-253 mm Hg] vs 240 mm Hg [161-309 mm Hg]; p = 0.003) and oxygenation index (before vs after: 5.9 [3.8-14.6] vs 4 [2.9-11]; p = 0.002). The average cost of CVVH in these patients was minor (≈3%) in comparison with the median total cost of NICU care per patient. CONCLUSIONS:We have provided CVVH to critically ill term and preterm neonates with MODS. CVVH improved fluid overload and oxygenation. The cost of CVVH was minimal compared with the overall cost of neonatal intensive care.

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Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction

De Luca,

Loi,

Tingay

et al. 2023

Seminars in Fetal and Neonatal Medicine

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Effect of inspired gas temperature on lung mechanics and gas exchange in neonates in normothermia or therapeutic hypothermia

Cited by 3 publications

References 36 publications

Expiratory braking defines the breathing patterns of asphyxiated neonates during therapeutic hypothermia

Expiratory braking defines the breathing patterns of asphyxiated neonates during therapeutic hypothermia

Continuous Venovenous Hemofiltration Performed by Neonatologists With Cardio-Renal Pediatric Dialysis Emergency Machine to Treat Fluid Overload During Multiple Organ Dysfunction Syndrome: A Case Series

Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction

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