Unsolved Mysteries: High-Frequency Jet Ventilation in the Neonatal ICU

Miller, Andrew G; Bartle, Renee M

doi:10.4187/respcare.08583

Cited by 1 publication

(1 citation statement)

References 13 publications

(14 reference statements)

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“…High-frequency oscillatory or jet ventilation is used in selected circumstances to rescue infants with respiratory failure on conventional ventilation or with severe air leaks. Some clinicians may use them as a primary respiratory support strategy, even though large meta-analyses demonstrate few differences in outcome (49, 51). Recent trials suggest that low tidal volume, targeted low-pressure ventilation may be of benefit for decreasing BPD (52).…”

Section: Postnatal Respiratory Supportmentioning

confidence: 99%

Advances in Neonatal Critical Care: Pushing at the Boundaries and Connecting to Long-Term Outcomes

Biban

Marlow

Pas

et al. 2021

Critical Care Medicine

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T he care of newborn infants has evolved over the past 50 years from essentially simple, anecdotal and empirical processes to evidence-based, high technology, intensive care medicine, accompanied by a dramatic decline in mortality and increasing intact survival of many fragile extremely preterm infants and improving outcomes for infants exposed to perinatal asphyxia. Many factors have been responsible for these improved outcomes, but they all stem from the development of Neonatology and Maternal-Fetal Medicine as clinical specialties in their own right. Through these organizational disciplines, physicians, nurses, and allied health professionals have developed as teams, formalizing training, quality control, and simulation programs to provide high quality, standardized, state-of-the-art care. However, despite the huge advances in knowledge, care for newborn babies still represents a very careful balance between benefit and harm.Around the time that the Society of Critical Care Medicine and Journal were being formed in 1971, care for newborn babies was usually carried out as part of the woman's maternity care and interest in the newborn was only slowly awakening. Many early attempts to improve care had floundered when unexpected complications ensued (Table 1). Despite this, dramatic falls in neonatal mortality had occurred over the 20th century associated with the introduction of better population nutrition and antisepsis (10). The seeds for the informed development of neonatal care had been sown, but recognizable Neonatal Critical Care emerged around this time with the recognition that the application of good science and the use of clinical trials could safely proceed.Prior to 1970, there was little consensus as to how to best care for the newborn in the minutes and hours after birth and little understanding of the importance of thermal control. Indeed, supplemental oxygen apart, there was no understanding of how to support respiration when hyaline membrane disease occurred. Infants often had all feeding and fluids withheld until their respiratory symptoms settled, and there was uncertainty over the use of antibiotics, which seemed to cause disastrous complications, and fear over complications of the use of pain relief. Where pioneers had started to develop intensive care practices, there was criticism of the cost of neonatal care in terms of the high rate of disability among survivors. By 1970, there had been one trial of "intensive care"-use of oxygen and a glucose-bicarbonate infusion-and few attempts to understand the potential neurologic and neurocognitive outcomes that are currently monitored prospectively. Even more starkly, parents were

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Section: Postnatal Respiratory Supportmentioning

confidence: 99%