Neonatal Assisted Ventilation: Predictors, Frequency, and Duration in a Mature Managed Care Organization

Abstract

Considerable variation exists in the utilization of ventilator support among infants of closely related gestational age. In addition, a number of medical risk factors influence the need for, and length of, assisted ventilation. These models explain much of the variance in LOV among preterm infants but explain substantially less among term infants.neonatal intensive care, assisted ventilation, Score for Neonatal Acute Physiology, resource consumption, prematurity.

Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas

“…In order to compare the two systems, two similar prototypes were employed to conduct the gas flow required to the binasal prong (Hudson ® , n° 1) via the inspiratory limb of the circuit. The binasal has two anterior projections, each around 1 cm long, which were used separately; one of the passages allowed < 20% of the total gas flow to escape (bearing in mind that the nasal CPAP technique allows leakage around the baby s nostrils and/or mouth), while to the other nozzle a fixed resistance of 30 cmH 2 O/l/s was applied (to simulate the neonatal airway 20,22 ) and a test lung were connected.…”

“…22 This last has been considered to be a ventilation mode with advantages over conventional mechanical ventilation in certain clinical situations, proving efficient at CO 2 elimination and capable of reducing the duration of ventilatory support and oxygen therapy because it makes use of different gas transport mechanisms than does conventional mechanical ventilation. 21,22 Lee et al, studying newborn babies, observed vibrations similar to those found in our study. They state that the vibrations produced by the water seal CPAP s bubbling are transmitted to the chests of the babies on this type of ventilatory support and could contribute to gas exchange.…”

“…8 The mechanism by which gas exchanges occur during high-frequency ventilation have not been completed explained, but they probably include direct ventilation of the proximal alveoli and increased diffusion because of the increased activity of the gas molecules or even by means of coaxial diffusion in which the air enters via the center and the CO 2 and other gasses are exhaled via the peripheries of the airways. 1,21,22 …”

“…[17][18][19][20][21] When CPAP is offered with a ventilator, the gas supplies are part of the apparatus and flow rate and FiO 2 are adjusted with specific devices for each parameter, while positive pressure is offered by an expiratory circuit on the mechanical ventilator. 5,22 With, homemade CPAP, also known as water-seal CPAP, flowmeters are used on the compressed air and oxygen supplies, with the total flow being worked out from their sum and controlling FiO 2 by means of their relative proportions in the mixture. The distal end of the expiratory circuit is submerged in a receptacle containing water the level of which in centimeters corresponds to the positive end expiratory pressure (PEEP).…”

Positive Changes Among Very Low Birth Weight Infant Apgar Scores That are Associated With the Neonatal Resuscitation Program in Illinois

“…Low Apgar scores are associated with increased neonatal morbidity and mortality in preterm newborns, 6 increased mortality in VLBW infants, 7 increased neonatal mortality among preterm and term infants 5,7 and need for neonatal resuscitation. 8,9 STUDY DESIGN A retrospective two-time-period cohort design was used: births before the introduction of NRP, 1985NRP, -1988; and births after the introduction of NRP, 1991-1995, in Illinois. The transition training interval, 1989-1990, was excluded from analysis.…”