Pulmonary - Impairment of oxygenation and ventilation from lung disease (surfactant deficiency disease, pneumonia, transient tachypnea of the newborn, meconium aspiration, etc.).Cardiovascular - Impairment of oxygenation from congestive heart failure and pulmonary edema (PDA, coarctation, etc.), or from shunting (cyanotic heart disease).Neurological - Intraventricular hemorrhage, intracranial hemorrhage, neonatal seizures, perinatal asphyxia, or other pathology which could lead to increased intracranial pressure.Infection - Sepsis, especially in the first day of life, and nosocomial infections and/or NEC in the first weeks of life.The most common cause of apnea in the NICU is apnea of prematurity, but first ALWAYS investigate and rule out the following disorders: SequelaeĪpnea in premature infants can result in a failure of the mechanisms that protect cerebral blood flow, resulting in ischemia and eventually leukomalacia.ĭuring apneic episodes, in an attempt to protect cerebral blood flowcardiac output is diverted away from the mesenteric arteries resulting in intestinal ischemia and possibly necrotizing enterocolitis (NEC). Apnea at UIHC is defined as cessation of breathing for 20 seconds with the above symptoms. PEEP and FiO2 were maintained throughout the study.Peer Review Status: Internally Peer Reviewed DefinitionĪpnea is a "pause in breathing of longer than 10 to 15 seconds, often associated with bradycardia, cyanosis, or both." (Martin et al). PCV), pressure-controlled ventilation associated with inspiratory time adjustment (PCV + Tins) and pressure-supported ventilation (PSV). Controlled volume ventilation (VCV) at a constant flow rate of 20 Lpm (VCV-20) and 40 Lpm (VCV-40), controlled pressure ventilation (VCV-40) was performed for 2 minutes at 10 minute intervals. In addition, the bacteriological filter was changed, the cuff pressure was increased and the presence of leaks in the mechanical fan circuits was verified.Īll patients underwent five hyperinflation maneuvers, the order being determined by randomization. In order to perform both interventions, the patients were placed in dorsal decubitus with a head elevated at 45 ° and submitted to closed tracheal aspiration, according to the recommendations of the American Association for Respiratory Care. Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information The following variables were evaluated: tidal volume, inspiratory time (Tins), mean airway pressure (Pmean), peak inspiratory flow (PIFR) and expiratory flow (PEFR), PIFR / PEFR and Bias Flow (PEFR-PIFR). The inspiratory time was adjusted so that the inspiratory flow reached the baseline. In the pressure controlled modes, the inspiratory pressure was increased every 5 cmH2O until the total pressure reached 40 cmH2O. In VCV mode, the volume was increased every 50mL, until reaching a maximum pressure of 40cmH2O. The ventilator hyperinflation was performed in five ventilatory modalities for five minutes, with an interval of 2 hours, the order being determined by randomization: controlled ventilation at volume (VCV) with constant flow of 20 (VCV20) Lpm and 40 Lpm (VCV40), controlled ventilation pressure ventilation (PCV), controlled pressure ventilation associated with inspiratory time adjustment (PCV + Tins) and support pressure ventilation (PSV). METHODS: A randomized crossover clinical trial was performed with 30 patients (66.5 ± 17.3 years) with hypersecretion. PURPOSE: To compare different ways of applying ventilator hyperinflation. Why Should I Register and Submit Results?.
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