Alex Veldman

Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit.

Background : Unplanned extubation events (UEE) are a serious hazard to patient safety, especially on a neonatal intensive care unit (NICU), where reestablishing a secure airway can be difficult. The following study was undertaken to analyze characteristics of UEE and develop prevention strategies.

Proposal for a New Scoring System in International Interhospital Air Transport

Several advanced scoring systems have been established for the assessment of patients in clinical intensive care medicine.1 Currently, the widespread use of these systems allows an assessment of outcome, as well as assisting in the optimal choice of treatment settings, for example, time point to admission to the ICU.2 Furthermore, scoring systems can be an advantageous tool for purposes such as quality control and improvement of cost effectiveness.3 Some of these scores have been modified to provide a consistent scoring system in transport medicine, as for example, the rapid acute physiology scoring (RAPS). RAPS, a truncated version of the acute physiology and chronic health evaluation (APACHE II) score, has proved to be a reliable and predictive measurement of patient severity, and physiologic stability, in short distance helicopter transport systems.4,5 As a modified ICU score, RAPS however, is naturally limited, as it solely ranks illness severity, whereas other transport related aspects, such as, specific risk factors, and limitations for aeromedical transport, are not considered.6 RAPS therefore seems to be feasible for short helicopter transport between intensive care units, rather than for international transport. In contrast,patients undergoing long distance interhospital transfer by air ambulance or commercial airline are, if at all, scored by the NACA (National Committee of Aeronautics) score system, which was introduced about 35 years ago during the Vietnam war (Table 1), and last modified in 1976.7 The aim of this score system was a rapid triage of patients evacuated from battlefields, and not the ranking of patients transported between hospitals. Although also modified to accommodate patients suffering from internal diseases, the NACA score system poorly reflects the complex setting of modern interhospital transfer and travel medicine.

Comparison of Effects of Perflubron and Surfactant Lung Lavage on Pulmonary Gas Exchange in a Piglet Model of Meconium Aspiration

In a piglet model of meconium aspiration we compared lavage with surfactant with that with perflubron (PFOB) and a control group. A human meconium suspension was instilled into piglets which were randomized in 3 (n = 6 each) groups. After lung injury, the control group was ventilated with high-frequency oscillatory ventilation (HFOV) without suctioning and lavage. A second group was lavaged with 10 ml/kg diluted surfactant, a third with 10 ml/kg pre-oxygenated PFOB. Thereafter, the animals of both groups were ventilated with HFOV. After lung injury by instillation of meconium, no further improvement in oxygenation was possible in animals of the control group and 3 piglets died during the ventilation. The subjects of the surfactant group improved promptly, and at the end of the study the arterial pO2 was significantly better than immediately after injury as compared with the other groups. Lavage with PFOB had intermediate effects in gas exchange and oxygenation compared to surfactant lavage. No differences were observed in arterial blood pressure and heart rate as well as in histological lung injury score between all groups. Lavage with exogenous surfactant as well as with PFOB improve pulmonary gas exchange in a piglet model of meconium aspiration.