Effect of the arterial oxygenation level on cardiac output, oxygen extraction, and oxygen consumption in low birth weight infants receiving mechanical ventilation

The SafeBoosC Phase II Randomised Clinical Trial: A Treatment Guideline for Targeted Near-Infrared-Derived Cerebral Tissue Oxygenation versus Standard Treatment in Extremely Preterm Infants

“…In drawing up the treatment guideline we used the premise that hypoxia and hyperoxia are risk factors for an adverse outcome in the preterm infant and should be avoided [10,11,12,13,14,15]. In addition to NIRS assessment of the cerebral circulation, a number of other techniques, particularly echocardiography, are used to assess the neonatal transitional circulation and related outcomes [1,16,17,18,19,20,21,22,23,24,25,26,27].…”

“…Therefore, the fractional inspired oxygen fraction (Fi O 2 ) should only be increased if Sa O 2 is below the normal range or low, even in the normal range [10]. Other potential actions relate to increasing Sa O 2 through improvement in lung recruitment by moderate increase in mean airway pressure [22,26,75].…”

“Shunt index” can be used to predict clinically significant patent ductus arteriosus in premature neonates in early post-natal life

“…In the study of Schulze et al, 19 on premature infants with mechanical ventilation and without ductal and arterial shunts, the shunt index ranged from 6% to 49%. In this study, the mean post-natal age of the premature infants was 42 hours (minimum-maximum, .…”

In Vitro Validation and Clinical Testing of an Indirect Calorimetry System for Ventilated Preterm Infants That Is Unaffected by Endotracheal Tube Leaks and Can Be Used during Nasal Continuous Positive Airway Pressure

“…We did not perform an in vitro validation of our system in increased Fio 2 because of the risk of methanol explosion. Yet, the calorimeter we used has been extensively validated in vitro in raised Fio 2 (6,24,25), and accuracy was acceptable up to an Fio 2 of 0.6. With a calorimeter producing a constant internal flow, continuous Vo 2 measurements at raised Fio 2 require considerable technical effort (19).…”

“…The routine use of uncuffed endotracheal tubes leads to unpredictable leakage of expired air through mouth and nose (tube leak) in up to 50% of ventilated neonates (4), and the commonly used nasal CPAP represents a maximal tube leak. In previous measurements of EE, many ventilated preterm infants with tube leaks had to be excluded from analysis (5,6), and no measurements during nasal CPAP have been reported. We, therefore, developed an indirect calorimetry system with the following capabilities: 1) accurate measurements in intubated preterm infants regardless of tube leak, 2) accurate measurements during nasal CPAP, 3) applicable in combination with pressure-controlled constant-flow ventilators, 4) applicable during increased Fio 2 , 5) accurate measurements of low absolute values of Vo 2 and Vco 2 , and 6) easy to use at the bedside without undue disturbance of the patient.…”