Inadequate humidification of respiratory gases during mechanical ventilation of the newborn.

Tarnow‐Mordi, William; Sutton, Philip P.; Wilkinson, A

doi:10.1136/adc.61.7.698

Cited by 16 publications

(7 citation statements)

References 4 publications

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“…The differences found in incubators and radiant warmers are similar to those found by others, 9,11 and reflect both the use of differing lengths of nonheated extension tubing after the airway temperature probe and whether the extension and temperature probe are heated by the incubator or radiant warmer. In this study, a larger temperature drop was found with the shorter extension used under radiant warmers.…”

Section: Discussionsupporting

confidence: 68%

“…Previous studies 2,3,9,10 and clinicians assumed that this temperature is a true measure of the gas temperature actually delivered to the lungs. In some cases, 9,11 the use of nonheated extensions on the inspiratory limb of the ventilator circuit means that this temperature probe can be more than 50 cm from the top of the endotracheal tube. This extension then passes through the heated environment of the incubator, changing both the temperature and humidity of the inspired gas.…”

Section: Discussionmentioning

confidence: 99%

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Inspired gas temperature in ventilated neonates

Davies

Dunster

Cartwright

2004

Pediatric Pulmonology

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Summary. The warming and humidification of inspired gases for ventilated neonates are routine. There are no data on the temperature of the gas at the airway opening in ventilated neonates. Is the inspired gas temperature at the airway opening, as expected and set on the humidifier, around 378C? We aimed to measure temperature at the airway opening and compare this with the circuit temperature. This was an observational study in a neonatal intensive care unit. Twenty-five mechanically ventilated infants were studied. All had humidifiers with chamber temperature set at 368C and the circuit temperature set at 378C. Two temperature probes were inserted and rested at the circuit-exit and at the airway opening, and temperatures were measured for 2 min in each infant. At this time, the circuit temperature was also noted. The mean (SD) temperature at the airway opening in infants nursed in incubators was 34.9 (1.2)8C, compared with radiant warmers where the mean (SD) was 33.1 (0.5)8C. The mean (SD) difference in temperature from the circuit temperature probe to the airway opening was greater under radiant warmers, with a mean (SD) drop of 3.9 (0.6)8C compared with a mean (SD) drop of 2.0 (1.3)8C in the incubators. In conclusion, the temperature at the circuit temperature probe does not reflect the temperature at the airway opening. Inspired gas temperatures are lower than the expected 378C with the normal circuits and usual humidifier settings.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Inspired gas temperature in ventilated neonates

Davies

Dunster

Cartwright

2004

Pediatric Pulmonology

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“…19 Moreover, avoiding endotracheal intubation is of benefit for mucociliary transport and humidification of inspired air, as well as decreasing the risk of airway damage and secondary infection 20,21 and the occurrence of lung barotrauma and volutrauma secondary to MV. 22 …”

Section: Early Extubation Among Preterm Infants With Irdsmentioning

confidence: 99%

Early Extubation and Nasal Continuous Positive Airway Pressure After Surfactant Treatment for Respiratory Distress Syndrome Among Preterm Infants <30 Weeks’ Gestation

et al. 2004

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ABSTRACT.Objective. To test the hypothesis that preterm infants with infant respiratory distress syndrome who are treated with nasal continuous positive airway pressure (NCPAP) and surfactant administration followed by immediate extubation and NCPAP application (SURF-NCPAP group) demonstrate less need for mechanical ventilation (MV), compared with infants who receive MV after surfactant administration (SURF-MV group).Methods. A prospective randomized study was conducted, in which infants <30 weeks' gestation were randomized to the SURF-NCPAP group or the SURF-MV group.Results. At 7 days of life, no patient in the SURF-NCPAP group but 6 patients (43%) in the SURF-MV group still were undergoing MV. The duration of oxygen therapy, NCPAP, and MV, the need for a second dose of surfactant, and the length of stay in the intensive care unit were significantly greater in the SURF-MV group.Conclusions. The immediate reinstitution of NCPAP after surfactant administration for infants with infant respiratory distress syndrome is safe and beneficial, as indicated by the lesser need for MV and the briefer requirement for respiratory supports, compared with the institution of MV after surfactant treatment. Moreover, this strategy contributed to reducing the need for surfactant treatment and reducing the time and costs involved in keeping the infants in the neonatal intensive care unit. Pediatrics 2004;113:e560 -e563. URL: http: //www.pediatrics.org/cgi/content/full/113/6/e560; continuous positive airway pressure, mechanical ventilation, surfactant, respiratory distress syndrome, infant.ABBREVIATIONS. a/APo 2 , arterial/alveolar oxygen tension ratio; iRDS, infant respiratory distress syndrome; MV, mechanical ventilation; NCPAP, nasal continuous positive airway pressure; SURF-MV, mechanical ventilation after surfactant treatment; SURF-NCPAP, nasal continuous positive airway pressure after surfactant treatment; Fio 2 , fraction of inspired oxygen; IVH, intraventricular hemorrhage; BPD, bronchopulmonary dysplasia; ROP, retinopathy of prematurity; PDA, patent ductus arteriosus.T he cornerstones of treatment of infant respiratory distress syndrome (iRDS) are artificial respiratory support and surfactant treatment. Among respiratory support techniques, nasal continuous positive airway pressure (NCPAP) 1 and mechanical ventilation (MV) 2 are known for their effectiveness in reducing the mortality and morbidity rates associated with iRDS. Moreover, early application of NCPAP 1 and early treatment with surfactant 3 are effective in decreasing the need for MV, with its related adverse effects. Unfortunately, these results are not always taken into account in neonatal intensive care units, and MV is often initiated after endotracheal intubation for surfactant administration, without consideration of the fact that many infants who are able to breathe spontaneously could be supported with NCPAP only. [4][5][6][7] The present study was planned to test the hypothesis that preterm infants (Ͻ30 weeks' gestation) with iRDS who were treated with N...

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“…The use of dry gas during routine respiratory changes may impair already compromised lungs, especially in infants with chronic obtructive pulmonary disease and adults with ARDS. Tarnow-Mordi et al [32,33] showed an increase in the incidence of pneumothorax and chronic lung disease in patients who were ventilated with inspired gas at low temperatures, implying a low inspired absolute humidity. Necrotizing tracheobronchitis [34], which has been described in several ICUs, has also been attributed to low inspired humidity leading to sloughing of tracheal and bronchial cells [35].…”

Section: Discussionmentioning

confidence: 99%

A new prototype of an electronic jet-ventilator and its humidification system

et al. 1999

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Background: Adequate humidification in long-term jet ventilation is a critical aspect in terms of clinical safety.Aim: To assess a prototype of an electronic jet-ventilator and its humidification system. Methods:Forty patients with respiratory insufficiency were randomly allocated to one of four groups. The criterion for inclusion in this study was respiratory insufficiency exhibiting a Murray score above 2. The four groups of patients were ventilated with three different respirators and four different humidification systems. Patients in groups A and B received superimposed high-frequency jet ventilation (SHFJV) by an electronic jet-ventilator either with (group A) or without (group B) an additional humidification system. Patients in group C received highfrequency percussive ventilation (HFPV) by a pneumatic high-frequency respirator, using a hot water humidifier for warming and moistening the inspiration gas. Patients in group D received conventional mechanical ventilation using a standard intensive care unit respirator with a standard humidification system. SHFJV and HFPV were used for a period of 100 h (4 days).Results: A significantly low inspiration gas temperature was noted in patients in group B, initially (27.2 ± 2.5°C) and after 2 days (28.0 ± 1.6°C) (P < 0.05). The percentage of relative humidity of the inspiration gas in patients in group B was also initially significantly low (69.8 ± 4.1%; P < 0.05) but rose to an average of 98 ± 2.8% after 2 h. The average percentage across all four groups amounted to 98 ± 0.4% after 2 h. Inflammation of the tracheal mucosa was found in patients in group B and the mucosal injury score (MIS) was significantly higher than in all the other groups. Patients in groups A, C and D showed no severe evidence of airway damage, exhibiting adequate values of relative humidity and temperature of the inspired gas.

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Inadequate humidification of respiratory gases during mechanical ventilation of the newborn.

Cited by 16 publications

References 4 publications

Inspired gas temperature in ventilated neonates

Inspired gas temperature in ventilated neonates

Early Extubation and Nasal Continuous Positive Airway Pressure After Surfactant Treatment for Respiratory Distress Syndrome Among Preterm Infants <30 Weeks’ Gestation

A new prototype of an electronic jet-ventilator and its humidification system

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Inadequate humidification of respiratory gases during mechanical ventilation of the newborn.

Cited by 16 publications

References 4 publications

Inspired gas temperature in ventilated neonates

Inspired gas temperature in ventilated neonates

Early Extubation and Nasal Continuous Positive Airway Pressure After Surfactant Treatment for Respiratory Distress Syndrome Among Preterm Infants &lt;30 Weeks’ Gestation

A new prototype of an electronic jet-ventilator and its humidification system

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Product

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Early Extubation and Nasal Continuous Positive Airway Pressure After Surfactant Treatment for Respiratory Distress Syndrome Among Preterm Infants <30 Weeks’ Gestation