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- van Kaam, Anton H, et al.
(författare)
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Incidence of hypo- and hyper-capnia in a cross-sectional European cohort of ventilated newborn infants.
- 2013
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Ingår i: Archives of Disease in Childhood. - : BMJ. - 1359-2998 .- 1468-2052. ; 98:4, s. F323-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the incidence of hypo- and hyper-capnia in a European cohort of ventilated newborn infants.DESIGN AND SETTING: Two-point cross-sectional prospective study in 173 European neonatal intensive care units.PATIENTS AND METHODS: Patient characteristics, ventilator settings and measurements, and blood gas analyses were collected for endotracheally ventilated newborn infants on two separate dates.RESULTS: A total of 1569 blood gas analyses were performed in 508 included patients with a mean±SD Pco2 of 48±12 mm Hg or 6.4±1.6 kPa (range 17-104 mm Hg or 2.3-13.9 kPa). Hypocapnia (Pco2<30 mm Hg or 4 kPa) and hypercapnia (Pco2>52 mm Hg or 7 kPa) was present in, respectively, 69 (4%) and 492 (31%) of the blood gases. Hypocapnia was most common in the first 3 days of life (7.3%) and hypercapnia after the first week of life (42.6%). Pco2 was significantly higher in preterm infants (49 mm Hg or 6.5 kPa) than term infants (43 mm Hg or 5.7 kPa) and significantly lower during pressure-limited ventilation (47 mm Hg or 6.3±1.6 kPa) compared with volume-targeted ventilation (51 mm Hg or 6.8±1.7 kPa) and high-frequency ventilation (50 mm Hg or 6.7±1.7 kPa).CONCLUSIONS: This study shows that hypocapnia is a relatively uncommon finding during neonatal ventilation. The higher incidence of hypercapnia may suggest that permissive hypercapnia has found its way into daily clinical practice.
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| 2. |
- van Kaam, Anton H, et al.
(författare)
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Surfactant replacement therapy in preterm infants : a European survey
- 2011
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Ingår i: Neonatology. - : S. Karger AG. - 1661-7800 .- 1661-7819. ; 100:1, s. 71-77
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Exogenous surfactant is an undisputed treatment for neonatal respiratory distress syndrome but its efficacy is highly dependent on the treatment strategy. International guidelines have published recommendations on the optimal surfactant replacement strategy.OBJECTIVE: To determine how evidence-based guidelines on surfactant replacement therapy are implemented in daily clinical practice.METHODS: Data on surfactant replacement therapy, including preparation, dosing and timing, were collected in 173 European neonatal intensive care units (NICUs) by questionnaire and in a cohort of preterm infants mechanically ventilated on two separate predefined dates in these units.RESULTS: All NICUs used animal-derived surfactant in the treatment of respiratory distress syndrome, with Poractant being most widely used (86%). The most frequently used first dose was 100 mg/kg (58%) and 200 mg/kg (39%) and all NICUs allowed for repeat dosing. 39% of the NICUs claimed to use prophylactic treatment (<15 min of life). Data on surfactant treatment were collected in 338 infants, with a median gestational age of 27 weeks and a birth weight of 860 g. All infants were treated with animal-derived surfactant. The median first dose was 168 mg/kg in the Poractant group compared with 100 mg/kg in the Beractant and Bovactant groups. Prophylactic treatment was used in 23% of the infants and 28% of the infants received surfactant >2 h after birth. 43% of the infants received multiple doses.CONCLUSIONS: With the exception of surfactant timing, guidelines on surfactant replacement therapy seem to be implemented in daily clinical practice in European NICUs.
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| 3. |
- van Kaam, Anton H, et al.
(författare)
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Ventilation practices in the neonatal intensive care unit : a cross-sectional study
- 2010
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Ingår i: Journal of Pediatrics. - : Elsevier BV. - 0022-3476 .- 1097-6833. ; 157:5, s. 767-U101
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess current ventilation practices in newborn infants. Study design We conducted a 2-point cross-sectional study in 173 European neonatal intensive care units, including 535 infants (mean gestational age 28 weeks and birth weight 1024 g). Patient characteristics, ventilator settings, and measurements were collected bedside from endotracheally ventilated infants. Results A total of 457 (85%) patients were conventionally ventilated. Time cycled pressure-limited ventilation was used in 59% of these patients, most often combined with synchronized intermittent mandatory ventilation (51%). Newer conventional ventilation modes like volume targeted and pressure support ventilation were used in, respectively, 9% and 7% of the patients. The mean tidal volume, measured in 84% of the conventionally ventilated patients, was 5.7 +/- 2.3 ml/kg. The mean positive end-expiratory pressure was 4.5 +/- 1.1 cmH(2)O and rarely exceeded 7 cmH(2)O. Conclusions Time cycled pressure-limited ventilation is the most commonly used mode in neonatal ventilation. Tidal volumes are usually targeted between 4 to 7 mL/kg and positive end-expiratory pressure between 4 to 6 cmH(2)O. Newer ventilation modes are only used in a minority of patients. (J Pediatr 2010; 157:767-71).
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