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Non-Invasive Mechanical Ventilation in Neonatology
Arnaldo Prata Barbosa, Vera Lúcia Jornada Krebs, Miriam Perez de Figueiredo
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00029]


Mechanical Ventilation of the Neonate: Principles and Strategies
Steven M. Donn
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00030]


Multiple Utilization Of Surfactant In Neonatology
Celso Moura Rebello
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00031]


Ventilatory support in persistent pulmonary hypertension of the newborn
Maria Esther Jurfest Ceccon, Werther Brunow de Carvalho
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00032]


Neurally adjusted ventilatory assist - NAVA
Werther Brunow de Carvalho, Marcelo Cunio Machado Fonseca
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00033]


Mechanical Ventilation Following Cardiac Surgery in Children
Alexandre Tellechea Rotta, Werther Brunow de Carvalho
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00034]


Analgesia and sedation in mechanical ventilation in neonatology
Maria Esther Jurfest Ceccon, Angélica Arantes Silva de Oliveira
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00035]


Nutrition in pediatric/neonatology patients submitted to mechanical ventilation
Artur F. Delgado, Mario Cicero Falcão, Simone Brasil Iglesias
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00036]


Weaning and Extubation in Pediatrics
Cíntia Johnston and Paulo Sérgio Lucas da Silva
[Abstract] [FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00037]



Abstracts


Non-Invasive Mechanical Ventilation in Neonatology
Arnaldo Prata Barbosa, Vera Lúcia Jornada Krebs, Miriam Perez de Figueiredo
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00029]

Non-invasive ventilation (NIV) is a form of mechanical ventilation that does not use an endotracheal tube, thus avoiding the complications associated with this invasive form of ventilatoy support. This chapter will emphasize the use of NIV with two pressure levels in the management of the neonate with respiratory failure.

The physiological principles of its application and the main indications of NIV are discussed, such as: (i) prevention and treatment of apnea of prematurity; (ii) early weaning and ventilatory support following tracheal extubation; (iii) treatment of hypoxemic respiratory failure; and (iv) neonatal resuscitation in the delivery room. The modes of administration, the type of devices, the initial ventilatory settings and the necessary interfaces for its use are emphasized. Finally, the authors address the care needed to manage the newborn undergoing NIV and the complications of this type of ventilatory support, as well as the possibility of using new devices, exclusively designed for NIV.
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Mechanical Ventilation of the Neonate: Principles and Strategies
Steven M. Donn
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00030]

The advent of microprocessor-based technology has revolutionalized the treatment of respiratory failure in the newborn. Clinicians are now able to customize ventilatory strategies to the specific pathophysiology of the patient. Sophisticated monitoring provides breath-to-breath feedback on patient-ventilator interactions. This paper will focus upon the basic principles of mechanical ventilation, and will review various strategies that may be employed to manage the wide range of respiratory disorders encountered by preterm and term newborn infants, including respiratory distress syndrome, meconium aspiration syndrome, persistent pulmonary hypertension of the newborn, and bronchopulmonary dysplasia.
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Multiple Utilization Of Surfactant In Neonatology
Celso Moura Rebello
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00031]

Surfactant replacement therapy for the treatment of respiratory distress syndrome (RDS) and other respiratory diseases in newborns has become one of the most active research areas in neonatology. This research has resulted in improved survival for preterm babies since becoming a routine treatment in the 1990s. The main characteristics of pulmonary surfactant, including its composition, pool, metabolism, inactivation and immediate effects after administration, are well-established. However, some doubts still remain about the use of exogenous surfactants  and must be addressed. The new generation of synthetic surfactants has raised questions regarding the choice of surfactant type, the ideal timing for treatment (prophylactic vs. early rescue strategy), the adequate dose and number of doses, new administration routes and the effects of the association between the use of antenatal steroids and the surfactant replacement therapy. There is also controversy surrounding the choice between early surfactant administration and the use of a nasal CPAP as an initial strategy to treat RDS and to reduce bronchopulmonary dysplasia (BPD). This article reviews basic and clinical aspects of surfactant replacement therapy for RDS and other respiratory diseases in newborns.
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Ventilatory support in persistent pulmonary hypertension of the newborn
Maria Esther Jurfest Ceccon, Werther Brunow de Carvalho
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00032]

Hypertension Pulmonary Persistent Neonatal (HPPN), the conventional mode and the indication of high-frequency oscillatory ventilation (HFOV). Present also other approaches, such as therapeutics use of exogenous surfactant, inhaled nitric oxide, phosphodiesterases inhibitors and extracorporeal membrane oxygenation.

Data Source: It has been used articles obtained in the Pub Med, Medline, Cochrane BVS, databases, in which the topics about mechanical ventilation in Hypertension Pulmonary Persistent Neonatal and others treatments used in the newborn with HPPN.

Conclusion: The effective treatments used in HPPN are a conventional, not very aggressive ventilatory strategy; HFOV; inhaled nitric oxide and vasodilators medications that act on the lungs rather than on the whole system, and, in newborns that do not respond to these treatments, the use of extracorporeal membrane oxygenation.
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Neurally adjusted ventilatory assist - NAVA
Werther Brunow de Carvalho, Marcelo Cunio Machado Fonseca
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00033]

The NAVA system is a new mode of assisted pulmonary mechanical ventilation (PMV) that uses the electric activity of the diaphragm (EAdi) to control the PMV device’s inspiratory (trigger) and expiratory cycle, as well as the magnitude and the profile of the inspiratory mechanical assistance [1]. It needs an esophageal catheter that measures the electric sign. This catheter is similar to a standard nasogastric tube in relation to the diameter and length, but it possesses a series of serial electrodes concentrically disposed in the wall of the probe. The minimum sign of EAdi is registered and the sensibility is based on an increase in the sign above a reference value. The NAVA cycling occurs when EAdi falls approximately 70% of the peak value. During NAVA the pressure and flow triggers stay as redundant systems that are activated if the catheter is not properly placed or if the airway trigger is sensitized in first place [2]. This differentiates this ventilation mode of any other, since the patient controls in a more direct way (neuroventilatory coupling) the mechanical ventilatory assistance.
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Mechanical Ventilation Following Cardiac Surgery in Children
Alexandre Tellechea Rotta, Werther Brunow de Carvalho
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00034]

The heart and lungs work in tandem to supply oxygen to be consumed by the various tissues. Maintenance of an adequate cardiorespiratory function is essential to the care of critically ill patients and can be accomplished with the use of medications, fluid management, as well as invasive and non-invasive respiratory support. Paradoxically, interventions designed to improve the function of one system may, at times, lead to unwanted effects on another. Positive pressure mechanical ventilation is one such intervention, as it can result in complex cardiovascular changes with decrease in cardiac output and reduced tissue oxygen delivery, despite an apparent increase in the arterial oxygen content^{1, 2}.

This article reviews the impact of spontaneous breathing and mechanical ventilation on the circulatory system (cardiorespiratory interactions) and discusses ventilation strategies for the management of children following surgery for repair or palliation of selected congenital cardiac defects.
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Analgesia and sedation in mechanical ventilation in neonatology
Maria Esther Jurfest Ceccon, Angélica Arantes Silva de Oliveira
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00035]

Objective: Present a review about the use of the analgesia and sedation of the newborn in mechanical ventilation, which are the most common drugs, their beneficial and adverse effects, weaning way of the drugs and the most common levels of pain.

Data Source: It has been used articles obtained in the Pub Med, Medline, Cochrane BVS, databases, in which the topics about sedation and analgesia in the newborn and the levels of the pain evaluation were approached.

Conclusions: The pain and the discomfort of the newborn in the mechanical ventilation are events that should be avoided. The levels of pain help the physician in the evaluation of the patient and the pharmacological treatment should be applied in an individual way.
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Nutrition in pediatric/neonatology patients submitted to mechanical ventilation
Artur F. Delgado, Mario Cicero Falcão, Simone Brasil Iglesias
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00036]

This review emphasizes the use of nutrition support how an important priority in the management of children with severe respiratory insufficiency. This situation causes metabolic deregulation leading to muscle proteolysis (hypercatabolism) and can cause hospital malnutrition that constitutes important risk factor for increases in morbidity, lethality, length of hospital stay, and medical costs. Sequential evaluation of nutritional status in the patient with acute respiratory disease should be assessed by clinical and laboratory procedures. Although there is general agreement that nutrition is an important element of critical care, there is much less clarity about the exact requirements of children with specific problems, including acute respiratory diseases. Enteral nutrition is the recommended method of artificial feeding in intensive care unit, including in patients with bronchopulmonary dysplasia and ventilator-associated pneumonia. Combined nutritional support is considered an optional tool to avoid energy deficiency during hypocaloric enteral nutrition. The trend towards earlier initiation of adequate metabolic-nutrition support based on protocols can improve the clinical condition of critically ill children with acute respiratory disease.
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Weaning and Extubation in Pediatrics
Cíntia Johnston and Paulo Sérgio Lucas da Silva
[FULL-TEXT INQUIRY] [BSP/CRMR/E-Pub/00037]

Mechanical ventilation is a life-supporting intervention that is used for a significant number of patients in ICUs. The current pediatric literature shows that the science of ventilator weaning and extubation remains undetermined. No optimal weaning method has been described for a more rapid and successful extubation. Protocol-based approaches to weaning may have potential benefits in advancing readiness to extubation, but no significant outcome differences have been found to date. The analysis of clinical markers of extubation success has not revealed any specific physiologic predictor of extubation success in children. However, a daily trial of readiness to extubate is the most effective technique to determine likelihood of success. Extubation failure rates range from 16% to 20% and bear little relation to the duration of mechanical ventilation. Upper airway obstruction is the primary cause of extubation failure in most pediatric studies. Therefore, efforts to decrease airway edema before extubation should be considered. Corticosteroids seem to be beneficial for infants and children, but definitive evidence of their efficacy is lacking.
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