Anthony J Orsini

Patient-Triggered Ventilation Increases Synchrony and Improves Ventilation In Neonates With Respiratory Distress Syndrome. † 1561

Patient-Triggered Ventilation Increases Synchrony and Improves Ventilation In Neonates With Respiratory Distress Syndrome. † 1561

The Incidence of Apnea after Discharge in Infants Less Than 34 Weeks Gestation with Normal Pre-Discharge Pneumocardiograms

The Incidence of Apnea after Discharge in Infants Less Than 34 Weeks Gestation with Normal Pre-Discharge Pneumocardiograms

Efficacy of Survanta Treatment in Ventilated Infants with Meconium Aspiration 1666

The presence of meconium in the airway can lead to atelectasis, airway obstruction, pneumothorax, inflammation and surfactant inactivation. We sought to investigate if infants who required intubation and mechanical ventilation for meconium aspiration might improve their respiratory status with surfactant treatment (Survanta, Ross). Methods: Infant admitted to the NICU who required intubation and mechanical ventilation for meconium aspiration were treated with survanta (4cc/kg). Time of treatment and subsequent doses was at the discretion of the Attending Neonatologist. Age at diagnosis of respiratory compromise, oxygenation index, age at treatment of survanta and age of extubation were documented. Results:

Early Use Of A Seven Day Course Of Dexamethasone Is More Likely To Require Additional Courses Of Steroid Therapy 992

The use of a seven day course of dexamethasone for the treatment of bronchopulmonary dysplasia (BPD) has become common in many neonatal intensive care nurseries. Although studies have shown the early use of seven days of dexamethasone to improve pulmonary mechanics and reduce chronic lung disease, there remains a number of infants who require additional courses of steroid therapy. The purpose of this study was to retrospectively compare infants who were treated successfully with a single seven day course of dexamethasone to infants who required additional courses of therapy. Methods: A chart review of twenty-three patients who received a seven day course of dexamethasone from 6.95 to 11/96 was performed. Students t-test was used to compare gestational age (GA), birth weight (BW), day of life dexamethasone was started and ventilator parameters before and after dexamethasone therapy. Treatment was considered successful if additional courses of dexamethasone were not required after the initial seven day course. Results: Thirteen of twenty-three patients (56%) were treated successfully with a single seven day course of dexamethasone. There were no differences in BW and GA between infants who required additional courses of dexamethasone (756±137g and 26±2.0 wks) and infants successfully treated (818±228g and 25.6±2.2 wks, p=0.4). Infants requiring additional courses of therapy were started on dexamethasone significantly earlier than infants who were treated successfully(11.3±6.5 vs. 21.5±14.4 days of life, p=0.05). A higher FiO_(2) and PIP was required at the time therapy was restarted compared to those same parameters at the completion of the 7 day course (p<0.03 and p<0.04, respectively). Conclusion: Although the early use of seven days of dexamethasone has been advocated for the treatment of BPD, these data suggest that infants treated earlier are more likely to require additional courses of therapy. We speculate that the infants receiving early dexamethasone may have been sicker which was not reflected by ventilator settings at the time of starting steroids.

Ventilator Management Practices Are Dependent Upon Time Of Day 1560

Recent evidence supporting the relationship between hypocapnia and poor neurodevelopmental outcome as well as the desire to limit pulmonary barotrauma has raised questions regarding optimal pCO2levels in neonates with respiratory distress syndrome (RDS). The purpose of this study was to examine the relationship between ventilator management practices and pCO2 levels. Methods: A retrospective chart review of the last 45 patients admitted for RDS was performed. All blood gas results (n=909) and resulting ventilator changes in the first 3 days of life were recorded. Any increase in pressure or IMV was considered as an increase in ventilator support. pCO2 values (mmHg) are grouped by the practitioners response to ventilator management. Blood gas results were divided by shift and compared by one-way ANOVA (shift 1=0800-1600, shift 2+1600-2400 and shift 3=2400-0800). Results: The mean BW and GA was 846.3±244g and 26.6±1.9wks. The mean pCO2 value which resulted in an increase in ventilator support was significantly higher during shift 1 compared to shift 2 (p<0.05) but not different from shift 3. There were no differences in mean pCO2values resulting in a decrease in ventilator support. pCO2 values resulting in no change in ventilator support were higher during shift 2 compared to shift 3, p<0.05. Table

Target PaCO2 Versus Actual PaCO2 Values In The Ventilatory Management Of Respiratory Distress Syndrome |[dagger]| 991

Normocapneic ventilatory support is the general goal in the management of respiratory distress syndrome (RDS). In an effort to minimize pulmonary barotauma, many neonatologists are now accepting “higher” values of PaCO2. We surveyed the physicians (n=6) and the nurse practitioners(n=3) involved with the ventilator decision making process to ascertain individual practitioner and group target PaCO2 values and weaning thresholds during the acute phase of RDS. Mean target values were compared to actual PaCO2 values measured in 102 neonates with RDS. The mean birth weight and gestational age was 870±247g and 27±2.6wks. Only babies on conventional mechanical ventilation who received surfactant were included. The target PaCO2 was determined to be 36 to 46 mmHg. Actual PaCO2 values are reported in epochs of 6 to 12 hours for the first 3 days of life. Table

HELIUM-OXYGEN GAS MIXTURES DECREASE RESISTANCE AND IMPROVE VENTILATION IN NEONATES WITH RESPIRATORY DISTRESS SYNDROME. 2048

HELIUM-OXYGEN GAS MIXTURES DECREASE RESISTANCE AND IMPROVE VENTILATION IN NEONATES WITH RESPIRATORY DISTRESS SYNDROME. 2048

AZOTEMIA ASSOCIATED WITH DECADRON FOR BPD IN NEONATES IS NOT CAUSED BY OLIGURIA. |[dagger]| 1398

Azotemia is associated with the use of decadron in infants being treated for bronchopulmonary dysplasia. The purpose of this study was to further characterize the azotemia reported in infants treated with steroids for BPD. We retrospectively examined twenty charts of infants who received at least a seven day course of decadron for the treatment of BPD. Infants who received decadron were matched for gestational age, weight and postnatal age with infants who did not receive decadron. Electrolytes, BUN and Creatinine levels were examined daily from one day prior to treatment (D0) through the seventh day. Daily intake and urine outputs were also examined. The mean±SD BW and GA were 819±274g and 26±2wks for the treated group compared to 820±247g and 26±2wk for the untreated group (p=NS). By Student t-test, BUN (mg/dl) was significantly elevated in the treated group from day one of treatment through day seven. Creatinine levels (mg/dl) were also elevated in the treated group compared to the untreated group on day 2(1.2±0.4 vs. 0.8±0.4) and on day 3 (1.2±0.5 vs. 0.8±0.3), p=0.02 for both comparison. There were no differences with respect to fluid intake, total caloric intake or protein intake. There was an increase in urine output in the decadron group on days 1, 3, 4 and 6 which may be explained by the hyperglycemia noted in some of the infants who were given decadron. These data show that the elevation in BUN associated with the use of decadron in neonates for the treatment of BPD is not related to a decrease in urine output and presumably not associated with an impaired GFR. We speculate that in the abscence of a renal etiology for an elevated BUN, the azotemia associated with the use of steroids in the treatment of BPD is due to increased catabolism. Table