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Händel C, Becher T, Miedema M, Kallio M, Papadouri T, Waldmann AD, Sophocleous L, Karaoli C, Yerworth R, Bayford R, Rimensberger PC, van Kaam AH, Frerichs I. Effect of routine suction on lung aeration in critically ill neonates and young infants measured with electrical impedance tomography. Sci Rep 2023; 13:20842. [PMID: 38012186 PMCID: PMC10682352 DOI: 10.1038/s41598-023-42965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/17/2023] [Indexed: 11/29/2023] Open
Abstract
Endotracheal suctioning is a widely used procedure to remove secretions from the airways of ventilated patients. Despite its prevalence, regional effects of this maneuver have seldom been studied. In this study, we explore its effects on regional lung aeration in neonates and young infants using electrical impedance tomography (EIT) as part of the large EU-funded multicenter observational study CRADL. 200 neonates and young infants in intensive care units were monitored with EIT for up to 72 h. EIT parameters were calculated to detect changes in ventilation distribution, ventilation inhomogeneity and ventilation quantity on a breath-by-breath level 5-10 min before and after suctioning. The intratidal change in aeration over time was investigated by means of regional expiratory time constants calculated from all respiratory cycles using an innovative procedure and visualized by 2D maps of the thoracic cross-section. 344 tracheal suctioning events from 51 patients could be analyzed. They showed no or very small changes of EIT parameters, with a dorsal shift of the center of ventilation by 0.5% of the chest diameter and a 7% decrease of tidal impedance variation after suctioning. Regional time constants did not change significantly. Routine suctioning led to EIT-detectable but merely small changes of the ventilation distribution in this study population. While still a measure requiring further study, the time constant maps may help clinicians interpret ventilation mechanics in specific cases.
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Affiliation(s)
- Claas Händel
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schlewig-Holstein, Campus Kiel, Kiel, Germany.
| | - Tobias Becher
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schlewig-Holstein, Campus Kiel, Kiel, Germany
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Merja Kallio
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, Arch. Makarios III Hospital, Nicosia, Cyprus
| | - Andreas D Waldmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Rostock, Rostock, Germany
| | - Louiza Sophocleous
- Department of Electrical and Computer Engineering, KIOS Research Center, University of Cyprus, Nicosia, Cyprus
| | - Christina Karaoli
- Neonatal Intensive Care Unit, Arch. Makarios III Hospital, Nicosia, Cyprus
| | - Rebecca Yerworth
- Medical Physics and Biomedical Engineering Department, University College London, London, UK
| | - Richard Bayford
- Department of Natural Sciences, Middlesex University, London, UK
| | - Peter C Rimensberger
- Division of Neonatology and Pediatric Intensive Care, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schlewig-Holstein, Campus Kiel, Kiel, Germany
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Hibberd J, Leontini J, Scott T, Pillow JJ, Miedema M, Rimensberger PC, Tingay DG. Neonatal high-frequency oscillatory ventilation: where are we now? Arch Dis Child Fetal Neonatal Ed 2023:fetalneonatal-2023-325657. [PMID: 37726160 DOI: 10.1136/archdischild-2023-325657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
High-frequency oscillatory ventilation (HFOV) is an established mode of respiratory support in the neonatal intensive care unit. Large clinical trial data is based on first intention use in preterm infants with acute respiratory distress syndrome. Clinical practice has evolved from this narrow population. HFOV is most often reserved for term and preterm infants with severe, and often complex, respiratory failure not responding to conventional modalities of respiratory support. Thus, optimal, and safe, application of HFOV requires the clinician to adapt mean airway pressure, frequency, inspiratory:expiratory ratio and tidal volume to individual patient needs based on pathophysiology, lung volume state and infant size. This narrative review summarises the status of HFOV in neonatal intensive care units today, the lessons that can be learnt from the past, how to apply HFOV in different neonatal populations and conditions and highlights potential new advances. Specifically, we provide guidance on how to apply an open lung approach to mean airway pressure, selecting the correct frequency and use of volume-targeted HFOV.
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Affiliation(s)
- Jakob Hibberd
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justin Leontini
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Thomas Scott
- Department of Mechanical and Product Design Engineering, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - J Jane Pillow
- School of Human Science, The University of Western Australia, Perth, Western Australia, Australia
- NCCU, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Martijn Miedema
- Neonatology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | | | - David Gerald Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Tingay DG, Pereira-Fantini PM, Miedema M, McCall KE, Perkins EJ, Dowse G, Schinckel N, Sourial M, Davis PG. Dynamic positive end-expiratory pressure strategies using time and pressure recruitment at birth reduces early expression of lung injury in preterm lambs. Am J Physiol Lung Cell Mol Physiol 2022; 323:L464-L472. [PMID: 35997273 DOI: 10.1152/ajplung.00047.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Positive end-expiratory pressure (PEEP) is critical to the preterm lung at birth, but the optimal PEEP level remains uncertain. The objective of this study was to determine the effect of maximum PEEP levels at birth on the physiological and injury response in preterm lambs. Steroid-exposed preterm lambs (124-127d gestation; n=65) were randomly assigned from birth to either 1) Positive pressure ventilation (PPV) at 8 cmH2O PEEP, or 3-min dynamic stepwise PEEP strategy (DynPEEP) with either 2) 20 cmH2O maximum PEEP (10 PEEP second steps), or 3) 14 cmH2O maximum PEEP (20 second steps), all followed by standardised PPV for 90 min. Lung mechanics, gas exchange, regional ventilation and aeration (electrical impedance tomography) and histological and molecular measures of lung injury were compared between groups. Dynamic compliance was greatest using maximum 20 cmH2O (DynPEEP). There were no differences in gas exchange, end-expiratory volume and ventilator requirements. Regional ventilation became more uniform with time following all PEEP strategies. For all groups, gene expression of markers of early lung injury were greater in the gravity non-dependent lung, and inversely related to magnitude of PEEP, being lowest in the 20 cmH2O DynPEEP group overall. PEEP levels had no impact on lung injury in the dependent lung. Transient high maximum PEEP levels using dynamic PEEP strategies may confer more lung protection at birth.
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Affiliation(s)
- David G Tingay
- Neonatology, The Royal Children's Hospital, Parkville, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research, The Royal Women's Hospital, Parkville, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Martijn Miedema
- Neonatology, The Royal Children's Hospital, Parkville, Australia.,Neonatology, Amsterdam UMC, University of Amsterdam, Amersterdam, The Netherlands
| | - Karen E McCall
- Neonatology, The Royal Children's Hospital, Parkville, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Elizabeth J Perkins
- Neonatology, The Royal Children's Hospital, Parkville, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Georgie Dowse
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Nicholas Schinckel
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Magdy Sourial
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia
| | - Peter G Davis
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia.,Newborn Research, The Royal Women's Hospital, Parkville, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
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Han D, Kuronuma K, Rozanski A, Budoff M, Miedema M, Nasir K, Shaw L, Rumberger J, Gransar H, Blumenthal R, Blaha M, Berman D. Implication Of Thoracic Aortic Calcification Over Coronary Calcium Score Regarding The 2018 Acc/aha Cholesterol Guideline: Results From The Cac Consortium. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sophocleous L, Waldmann AD, Becher T, Kallio M, Rahtu M, Miedema M, Papadouri T, Karaoli C, Tingay DG, Van Kaam AH, Yerworth R, Bayford R, Frerichs I. Effect of sternal electrode gap and belt rotation on the robustness of pulmonary electrical impedance tomography parameters. Physiol Meas 2020; 41:035003. [DOI: 10.1088/1361-6579/ab7b42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tingay DG, Pereira-Fantini PM, Oakley R, McCall KE, Perkins EJ, Miedema M, Sourial M, Thomson J, Waldmann A, Dellaca RL, Davis PG, Dargaville PA. Gradual Aeration at Birth Is More Lung Protective Than a Sustained Inflation in Preterm Lambs. Am J Respir Crit Care Med 2020; 200:608-616. [PMID: 30730759 DOI: 10.1164/rccm.201807-1397oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: The preterm lung is susceptible to injury during transition to air breathing at birth. It remains unclear whether rapid or gradual lung aeration at birth causes less lung injury.Objectives: To examine the effect of gradual and rapid aeration at birth on: 1) the spatiotemporal volume conditions of the lung; and 2) resultant regional lung injury.Methods: Preterm lambs (125 ± 1 d gestation) were randomized at birth to receive: 1) tidal ventilation without an intentional recruitment (no-recruitment maneuver [No-RM]; n = 19); 2) sustained inflation (SI) until full aeration (n = 26); or 3) tidal ventilation with an initial escalating/de-escalating (dynamic) positive end-expiratory pressure (DynPEEP; n = 26). Ventilation thereafter continued for 90 minutes at standardized settings, including PEEP of 8 cm H2O. Lung mechanics and regional aeration and ventilation (electrical impedance tomography) were measured throughout and correlated with histological and gene markers of early lung injury.Measurements and Main Results: DynPEEP significantly improved dynamic compliance (P < 0.0001). An SI, but not DynPEEP or No-RM, resulted in preferential nondependent lung aeration that became less uniform with time (P = 0.0006). The nondependent lung was preferential ventilated by 5 minutes in all groups, with ventilation only becoming uniform with time in the No-RM and DynPEEP groups. All strategies generated similar nondependent lung injury patterns. Only an SI caused greater upregulation of dependent lung gene markers compared with unventilated fetal controls (P < 0.05).Conclusions: Rapidly aerating the preterm lung at birth creates heterogeneous volume states, producing distinct regional injury patterns that affect subsequent tidal ventilation. Gradual aeration with tidal ventilation and PEEP produced the least lung injury.
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Affiliation(s)
- David G Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia.,Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics and
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and
| | - Regina Oakley
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Karen E McCall
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Martijn Miedema
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Magdy Sourial
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Jessica Thomson
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | - Raffaele L Dellaca
- Dipartimento di Elettronica, Informazione e Ingegneria Biomedica, Politecnico di Milano University, Milan, Italy
| | - Peter G Davis
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter A Dargaville
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatal and Paediatric Intensive Care Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia; and.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Onland W, Hutten J, Miedema M, Bos LD, Brinkman P, Maitland-van der Zee AH, van Kaam AH. Precision Medicine in Neonates: Future Perspectives for the Lung. Front Pediatr 2020; 8:586061. [PMID: 33251166 PMCID: PMC7673376 DOI: 10.3389/fped.2020.586061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication of pre-term birth with long lasting sequelae. Since its first description more than 50 years ago, many large randomized controlled trials have been conducted, aiming to improve evidence-based knowledge on the optimal strategies to prevent and treat BPD. However, most of these intervention studies have been performed on a population level without regard for the variation in clinical and biological diversity (e.g., gestational age, ethnicity, gender, or disease progression) between patients that is driven by the complex interaction of genetic pre-disposition and environmental exposures. Nevertheless, clinicians provide daily care such as lung protective interventions on an individual basis every day despite the fact that research supporting individualized or precision medicine for monitoring or treating pre-term lungs is immature. This narrative review summarizes four potential developments in pulmonary research that might facilitate the process of individualizing lung protective interventions to prevent development of BPD. Electrical impedance tomography and electromyography of the diaphragm are bedside monitoring tools to assess regional changes in lung volume and ventilation and spontaneous breathing effort, respectively. These non-invasive tools allow a more individualized optimization of invasive and non-invasive respiratory support. Investigation of the genomic variation in caffeine metabolism in pre-term infants can be used to optimize and individualize caffeine dosing regimens. Finally, volatile organic compound analysis in exhaled breath might accurately predict BPD at an early stage of the disease, enabling clinicians to initiate preventive strategies for BPD on an individual basis. Before these suggested diagnostic or monitoring tools can be implemented in daily practice and improve individualized patient care, future research should address and overcome their technical difficulties, perform extensive external validation and show their additional value in preventing BPD.
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Affiliation(s)
- Wes Onland
- Department of Neonatology, Amsterdam University Medical Centers, VU University Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Jeroen Hutten
- Department of Neonatology, Amsterdam University Medical Centers, VU University Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn Miedema
- Department of Neonatology, Amsterdam University Medical Centers, VU University Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Lieuwe D Bos
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Brinkman
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Amsterdam University Medical Centers, VU University Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, Netherlands
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Tingay DG, Togo A, Pereira-Fantini PM, Miedema M, McCall KE, Perkins EJ, Thomson J, Dowse G, Sourial M, Dellacà RL, Davis PG, Dargaville PA. Aeration strategy at birth influences the physiological response to surfactant in preterm lambs. Arch Dis Child Fetal Neonatal Ed 2019; 104:F587-F593. [PMID: 31498776 DOI: 10.1136/archdischild-2018-316240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND The influence of pressure strategies to promote lung aeration at birth on the subsequent physiological response to exogenous surfactant therapy has not been investigated. OBJECTIVES To compare the effect of sustained inflation (SI) and a dynamic positive end-expiratory pressure (PEEP) manoeuvre at birth on the subsequent physiological response to exogenous surfactant therapy in preterm lambs. METHODS Steroid-exposed preterm lambs (124-127 days' gestation; n=71) were randomly assigned from birth to either (1) positive-pressure ventilation (PPV) with no recruitment manoeuvre; (2) SI until stable aeration; or (3) 3 min dynamic stepwise PEEP strategy (maximum 14-20 cmH2O; dynamic PEEP (DynPEEP)), followed by PPV for 60 min using a standardised protocol. Surfactant (200 mg/kg poractant alfa) was administered at 10 min. Dynamic compliance, gas exchange and regional ventilation and aeration characteristics (electrical impedance tomography) were measured throughout and compared between groups, and with a historical group (n=38) managed using the same strategies without surfactant. RESULTS Compliance increased after surfactant only in the DynPEEP group (p<0.0001, repeated measures analysis of variance), being 0.17 (0.10, 0.23) mL/kg/cmH2O higher at 60 min than the SI group. An SI resulted in the least uniform aeration, and unlike the no-recruitment and DynPEEP groups, the distribution of aeration and tidal ventilation did not improve with surfactant. All groups had similar improvements in oxygenation post-surfactant compared with the corresponding groups not treated with surfactant. CONCLUSIONS A DynPEEP strategy at birth may improve the response to early surfactant therapy, whereas rapid lung inflation with SI creates non-uniform aeration that appears to inhibit surfactant efficacy.
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Affiliation(s)
- David Gerald Tingay
- Neonatology, Royal Children's Hospital, Parkville, Victoria, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Andrea Togo
- Neonatology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Martijn Miedema
- Neonatology, Royal Children's Hospital, Parkville, Victoria, Australia.,Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen E McCall
- Neonatology, Royal Children's Hospital, Parkville, Victoria, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatology, Royal Children's Hospital, Parkville, Victoria, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jessica Thomson
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Georgie Dowse
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Magdy Sourial
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Raffaele L Dellacà
- TBM Lab, Dipartimento di Elettronica, Informazione e BioIngegneria (DEIB), Politecnico di Milano University, Milan, Italy
| | - Peter G Davis
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Anderson Dargaville
- Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal and Paediatric Intensive Care Unit, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Miedema M, Adler A, McCall KE, Perkins EJ, van Kaam AH, Tingay DG. Electrical impedance tomography identifies a distinct change in regional phase angle delay pattern in ventilation filling immediately prior to a spontaneous pneumothorax. J Appl Physiol (1985) 2019; 127:707-712. [PMID: 31268827 DOI: 10.1152/japplphysiol.00973.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pneumothoraxes are common in preterm infants and are a major cause of morbidity. Early detection and treatment of pneumothoraxes are vital to minimize further respiratory compromise. Electrical impedance tomography (EIT) has been suggested as a method of rapidly detecting pneumothoraxes at the bedside. Our objective was to define the EIT-derived regional phase angle differences in filling characteristics before and during spontaneous pneumothoraxes in preterm lambs. Preterm lambs (124-127-day gestation) were ventilated with high-frequency oscillatory ventilation for 120 min. EIT data and cardiorespiratory parameters were monitored continuously and recorded for 3 min every 15 min. Six animals spontaneously developed a pneumothorax within a gravity-nondependent quadrant of the lung and were included for this analysis. Changes in end-expiratory lung impedance (EELI), ventilation, and phase angle delay were calculated in the four lung quadrants at the onset of the pneumothorax and 15 and 30 min prior. At the onset of the pneumothorax, all animals showed a clear increase in EELI in the affected lung quadrant. Fifteen and thirty minutes before the pneumothorax there was a significant phase angle delay between the nondependent and dependent lung. At 1 min before pneumothorax this phase angle delay was isolated just to the affected quadrant (nondependent). These findings are the first description of the events within the lung at initiation of a pneumothorax, demonstrating distinct predictive changes in air-filling characteristics before the occurrence of pneumothorax. This suggests that EIT may be able to accurately identify the onset of a pneumothorax.NEW & NOTEWORTHY In this article we describe for the first time predictive changes in electrical impedance tomography-based regional filling characteristics of the lung before the onset of a one-sided pneumothorax in six preterm lambs ventilated with high-frequency oscillatory ventilation. This can give clinicians bedside information to change treatment of preterm infants and prevent pneumothorax as life-threatening event from happening.
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Affiliation(s)
- Martijn Miedema
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Karen E McCall
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Affiliation(s)
- Roos J S Vliegenthart
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neonatology, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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11
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Kallio M, van der Zwaag AS, Waldmann AD, Rahtu M, Miedema M, Papadouri T, van Kaam AH, Rimensberger PC, Bayford R, Frerichs I. Initial Observations on the Effect of Repeated Surfactant Dose on Lung Volume and Ventilation in Neonatal Respiratory Distress Syndrome. Neonatology 2019; 116:385-389. [PMID: 31505498 DOI: 10.1159/000502612] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exogenous surfactant administration is an essential part of respiratory distress syndrome treatment in preterm infants. Current guidelines recommend the first dose to be given as early as possible, followed by an additional dose if symptoms persist. The effect of additional dosing on regional ventilation and lung volume has not been investigated so far. OBJECTIVES The aim of this study was to assess changes in ventilation distribution, lung volume, and gas exchange following repeated surfactant dosing in invasively ventilated neonates. METHOD Preterm infants requiring invasive ventilation and repeated surfactant treatment, and participating in the prospective observational multicenter trial "Continuous Regional Analysis Device for neonate Lung (CRADL)" were included in this analysis. Ventilation distribution, end-expiratory lung impedance (EELZ), and tidal impedance variation were determined by electrical impedance tomography together with clinical parameters before and after repeat endotracheal surfactant treatment. RESULTS Nine neonates (gestational age 32.7 ± 2.7 weeks, weight 1,724 ± 691 g) received an additional dose of surfactant at a median postnatal age of 33.5 h (IQR 9.1-46.6). One patient was excluded from the analysis due to simultaneous interventions confounding data analysis. Repeated surfactant dose did not significantly affect ventilation distribution. There were no significant changes in EELZ or tidal impedance variation. SpO2/FiO2 increased from 248 ± 104 to 367 ± 92 (p = 0.001), while FiO2 was reduced from 0.41 ± 0.20 to 0.27 ± 0.10 (p = 0.004). Expiratory tidal volume fell from 4.3 ± 0.6 to 3.0 ± 1.2 mL/kg (p = 0.03), while other ventilator and clinical parameters remained stable. CONCLUSIONS Repeated surfactant dose during invasive ventilation improves oxygenation without measurable changes in EELZ or ventilation distribution.
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Affiliation(s)
- Merja Kallio
- PEDEGO Research Unit, Department of Children and Adolescents, Oulu University Hospital, University of Oulu, Oulu, Finland,
| | - Anne-Sea van der Zwaag
- Department of Mechanical Engineering, Delft University of Technology, Delft, The Netherlands.,SenTec AG, EIT Branch, Landquart, Switzerland
| | - Andreas D Waldmann
- SenTec AG, EIT Branch, Landquart, Switzerland.,Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany
| | - Marika Rahtu
- PEDEGO Research Unit, Department of Children and Adolescents, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thalia Papadouri
- Neonatal Intensive Care Unit, Archbishop Makarios III Hospital, Nicosia, Cyprus
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter C Rimensberger
- Division of Neonatology and Pediatric Intensive Care, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Richard Bayford
- Department of Natural Sciences, Middlesex University, London, United Kingdom
| | - Inéz Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
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12
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Vliegenthart R, Miedema M, Hutten GJ, van Kaam AH, Onland W. High versus standard dose caffeine for apnoea: a systematic review. Arch Dis Child Fetal Neonatal Ed 2018; 103:F523-F529. [PMID: 29437799 DOI: 10.1136/archdischild-2017-313556] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/15/2017] [Accepted: 11/23/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Placebo-controlled trials have shown that caffeine is highly effective in treating apnoea of prematurity and reduces the risk of bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI). OBJECTIVE To identify, appraise and summarise studies investigating the modulating effect of different caffeine dosages. METHODS A systematic review identified all randomised controlled trials (RCTs) comparing a high versus a standard caffeine treatment regimen in infants with a gestational age <32 weeks, by searching the main electronic databases and abstracts of the Pediatric Academic Societies. Studies comparing caffeine to placebo or theophylline only were excluded. Primary outcomes were BPD and mortality at 36 weeks postmenstrual age. Secondary key-outcome was neurodevelopmental outcome at 12 and 24 months corrected age. Meta-analysis was performed using RevMan 5.3. RESULTS Six RCTs including 620 infants were identified. Meta-analysis showed a significant decrease in BPD, the combined outcome BPD or mortality, and failure to extubate in infants allocated to a higher caffeine dose. No differences were found in mortality alone and NDI. The quality of the outcome measures were deemed low to very low according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. CONCLUSIONS Although this review suggests that administering a higher dose of caffeine might enhance its beneficial effect on death or BPD, firm recommendations on the optimal caffeine dose cannot be given due to the low level of evidence. A large RCT is urgently needed to confirm or refute these findings and determine the optimal dose of caffeine.
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Affiliation(s)
- Roos Vliegenthart
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, The Netherlands
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, The Netherlands
| | - Gerard J Hutten
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Noord-Holland, The Netherlands
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13
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Khodadad D, Nordebo S, Müller B, Waldmann A, Yerworth R, Becher T, Frerichs I, Sophocleous L, van Kaam A, Miedema M, Seifnaraghi N, Bayford R. Optimized breath detection algorithm in electrical impedance tomography. Physiol Meas 2018; 39:094001. [PMID: 30074906 DOI: 10.1088/1361-6579/aad7e6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This paper defines a method for optimizing the breath delineation algorithms used in electrical impedance tomography (EIT). In lung EIT the identification of the breath phases is central for generating tidal impedance variation images, subsequent data analysis and clinical evaluation. The optimisation of these algorithms is particularly important in neonatal care since the existing breath detectors developed for adults may give insufficient reliability in neonates due to their very irregular breathing pattern. APPROACH Our approach is generic in the sense that it relies on the definition of a gold standard and the associated definition of detector sensitivity and specificity, an optimisation criterion and a set of detector parameters to be investigated. The gold standard has been defined by 11 clinicians with previous experience with EIT and the performance of our approach is described and validated using a neonatal EIT dataset acquired within the EU-funded CRADL project. MAIN RESULTS Three different algorithms are proposed that improve the breath detector performance by adding conditions on (1) maximum tidal breath rate obtained from zero-crossings of the EIT breathing signal, (2) minimum tidal impedance amplitude and (3) minimum tidal breath rate obtained from time-frequency analysis. As a baseline a zero-crossing algorithm has been used with some default parameters based on the Swisstom EIT device. SIGNIFICANCE Based on the gold standard, the most crucial parameters of the proposed algorithms are optimised by using a simple exhaustive search and a weighted metric defined in connection with the receiver operating characterics. This provides a practical way to achieve any desirable trade-off between the sensitivity and the specificity of the detectors.
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Affiliation(s)
- D Khodadad
- Department of Physics and Electrical Engineering, Linnaeus University, Växjö, Sweden
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14
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Sophocleous L, Frerichs I, Miedema M, Kallio M, Papadouri T, Karaoli C, Becher T, Tingay DG, van Kaam AH, Bayford R, Waldmann AD. Clinical performance of a novel textile interface for neonatal chest electrical impedance tomography. Physiol Meas 2018. [DOI: 10.1088/1361-6579/aab513] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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15
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Farrell O, Perkins EJ, Black D, Miedema M, Paul JD, Pereira-Fantini PM, Tingay DG. Volume guaranteed? Accuracy of a volume-targeted ventilation mode in infants. Arch Dis Child Fetal Neonatal Ed 2018; 103:F120-F125. [PMID: 28659362 DOI: 10.1136/archdischild-2017-312640] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/28/2017] [Accepted: 05/01/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Volume-targeted ventilation (VTV) is widely used and may reduce lung injury, but this assumes the clinically set tidal volume (VTset) is accurately delivered. This prospective observational study aimed to determine the relationship between VTset, expiratory VT (VTe) and endotracheal tube leak in a modern neonatal -volume-targeted ventilator (VTV) and the resultant partial arterial pressure of carbon dioxide (PaCO2) relationship with and without VTV. DESIGN Continuous inflations were recorded for 24 hours in 100 infants, mean (SD) 34 (4) weeks gestation and 2483 (985) g birth weight, receiving synchronised mechanical ventilation (SLE5000, SLE, UK) with or without VTV and either the manufacturer's V4 (n=50) or newer V5 (n=50) VTV algorithm. The VTset, VTe and leak were determined for each inflation (maximum 90 000/infant). If PaCO2 was sampled (maximum of 2 per infant), this was compared with the average VTe data from the preceding 15 min. RESULTS A total of 7 497 137 inflations were analysed. With VTV enabled (77 infants), the VTset-VTe bias (95% CI) was 0.03 (-0.12 to 0.19) mL/kg, with a median of 80% of VTe being ±1.0 mL/kg of VTset. Endotracheal tube leak up to 30% influenced VTset-VTe bias with the V4 (r2=-0.64, p<0.0001; linear regression) but not V5 algorithm (r2=0.04, p=0.21). There was an inverse linear relationship between VTe and PaCO2 without VTV (r2=0.26, p=0.004), but not with VTV (r2=0.04, p=0.10), and less PaCO2 within 40-60 mm Hg, 53% versus 72%, relative risk (95% CI) 1.7 (1.0 to 2.9). CONCLUSION VTV was accurate and reliable even with moderate leak and PaCO2 more stable. VTV algorithm differences may exist in other devices.
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Affiliation(s)
- Olivia Farrell
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Don Black
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Martijn Miedema
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Neonatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Joel Don Paul
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - David Gerald Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Neonatology, Royal Children's Hospital, Melbourne, Australia
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16
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Miedema M, McCall KE, Perkins EJ, Oakley RB, Pereira-Fantini PM, Rajapaksa AE, Waldmann AD, Tingay DG, van Kaam AH. Lung Recruitment Strategies During High Frequency Oscillatory Ventilation in Preterm Lambs. Front Pediatr 2018; 6:436. [PMID: 30723711 PMCID: PMC6349831 DOI: 10.3389/fped.2018.00436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/31/2018] [Indexed: 01/28/2023] Open
Abstract
Background: High frequency oscillatory ventilation (HFOV) is considered a lung protective ventilation mode in preterm infants only if lung volume is optimized. However, whilst a "high lung volume strategy" is advocated for HFOV in preterm infants this strategy is not precisely defined. It is not known to what extent lung recruitment should be pursued to provide lung protection. In this study we aimed to determine the relationship between the magnitude of lung volume optimization and its effect on gas exchange and lung injury in preterm lambs. Methods: 36 surfactant-deficient 124-127 d lambs commenced HFOV immediately following a sustained inflation at birth and were allocated to either (1) no recruitment (low lung volume; LLV), (2) medium- (MLV), or (3) high lung volume (HLV) recruitment strategy. Gas exchange and lung volume changes over time were measured. Lung injury was analyzed by post mortem pressure-volume curves, alveolar protein leakage, gene expression, and histological injury score. Results: More animals in the LLV developed a pneumothorax compared to both recruitment groups. Gas exchange was superior in both recruitment groups compared to LLV. Total lung capacity tended to be lower in the LLV group. Other parameters of lung injury were not different. Conclusions: Lung recruitment during HFOV optimizes gas exchange but has only modest effects on lung injury in a preterm animal model. In the HLV group aiming at a more extensive lung recruitment gas exchange was better without affecting lung injury.
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Affiliation(s)
- Martijn Miedema
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Karen E McCall
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Regina B Oakley
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Anushi E Rajapaksa
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | | | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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17
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Miedema M, McCall KE, Perkins EJ, Sourial M, Böhm SH, Waldmann A, van Kaam AH, Tingay DG. First Real-Time Visualization of a Spontaneous Pneumothorax Developing in a Preterm Lamb Using Electrical Impedance Tomography. Am J Respir Crit Care Med 2017; 194:116-8. [PMID: 27367888 DOI: 10.1164/rccm.201602-0292le] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martijn Miedema
- 1 Murdoch Children's Research Institute Melbourne, Australia.,2 Academic Medical Centre Amsterdam Amsterdam, the Netherlands
| | - Karen E McCall
- 1 Murdoch Children's Research Institute Melbourne, Australia.,3 University College Dublin Dublin, Ireland
| | | | - Magdy Sourial
- 1 Murdoch Children's Research Institute Melbourne, Australia
| | | | | | | | - David G Tingay
- 1 Murdoch Children's Research Institute Melbourne, Australia.,5 Royal Women's Hospital Melbourne, Australia.,6 Royal Children's Hospital Melbourne, Australia and.,7 University of Melbourne Melbourne, Australia
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18
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McCall KE, Waldmann AD, Pereira-Fantini P, Oakley R, Miedema M, Perkins EJ, Davis PG, Dargaville PA, Böhm SH, Dellacà R, Sourial M, Zannin E, Rajapaksa AE, Tan A, Adler A, Frerichs I, Tingay DG. Time to lung aeration during a sustained inflation at birth is influenced by gestation in lambs. Pediatr Res 2017; 82:712-720. [PMID: 28604757 DOI: 10.1038/pr.2017.141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/20/2017] [Indexed: 11/10/2022]
Abstract
BackgroundCurrent sustained lung inflation (SI) approaches use uniform pressures and durations. We hypothesized that gestational-age-related mechanical and developmental differences would affect the time required to achieve optimal lung aeration, and resultant lung volumes, during SI delivery at birth in lambs.Methods49 lambs, in five cohorts between 118 and 139 days of gestation (term 142 d), received a standardized 40 cmH2O SI, which was delivered until 10 s after lung volume stability (optimal aeration) was visualized on real-time electrical impedance tomography (EIT), or to a maximum duration of 180 s. Time to stable lung aeration (Tstable) within the whole lung, gravity-dependent, and non-gravity-dependent regions, was determined from EIT recordings.ResultsTstable was inversely related to gestation (P<0.0001, Kruskal-Wallis test), with the median (range) being 229 (85,306) s and 72 (50,162) s in the 118-d and 139-d cohorts, respectively. Lung volume at Tstable increased with gestation from a mean (SD) of 20 (17) ml/kg at 118 d to 56 (13) ml/kg at 139 d (P=0.002, one-way ANOVA). There were no gravity-dependent regional differences in Tstable or aeration.ConclusionsThe trajectory of aeration during an SI at birth is influenced by gestational age in lambs. An understanding of this may assist in developing SI protocols that optimize lung aeration for all infants.
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Affiliation(s)
- Karen E McCall
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | | | - Prue Pereira-Fantini
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Regina Oakley
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Martijn Miedema
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Peter G Davis
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter A Dargaville
- Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Raffaele Dellacà
- TBM Lab, Dipartimento di Elettronica, Informazione e Ingegneria Biomedica-DEIB, Politecnico di Milano University, Milano, Italy
| | - Magdy Sourial
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emanuela Zannin
- TBM Lab, Dipartimento di Elettronica, Informazione e Ingegneria Biomedica-DEIB, Politecnico di Milano University, Milano, Italy
| | - Anushi E Rajapaksa
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Andre Tan
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Andy Adler
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - David G Tingay
- Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Neonatal Research, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia
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19
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Miedema M, Waldmann A, McCall KE, Böhm SH, van Kaam AH, Tingay DG. Individualized Multiplanar Electrical Impedance Tomography in Infants to Optimize Lung Monitoring. Am J Respir Crit Care Med 2017; 195:536-538. [DOI: 10.1164/rccm.201607-1370le] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martijn Miedema
- Murdoch Children’s Research InstituteMelbourne, Australia
- Academic Medical Centre AmsterdamAmsterdam, the Netherlands
| | | | - Karen E. McCall
- Murdoch Children’s Research InstituteMelbourne, Australia
- University College DublinDublin, Ireland
| | | | | | - David G. Tingay
- Murdoch Children’s Research InstituteMelbourne, Australia
- Royal Children’s HospitalMelbourne, Australiaand
- University of MelbourneMelbourne, Australia
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20
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van der Burg PS, de Jongh FH, Miedema M, Frerichs I, van Kaam AH. Effect of Minimally Invasive Surfactant Therapy on Lung Volume and Ventilation in Preterm Infants. J Pediatr 2016; 170:67-72. [PMID: 26724118 DOI: 10.1016/j.jpeds.2015.11.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/12/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the changes in (regional) lung volume and gas exchange during minimally invasive surfactant therapy (MIST) in preterm infants with respiratory distress syndrome. STUDY DESIGN In this prospective observational study, infants requiring a fraction of inspired oxygen (FiO2) ≥ 0.30 during nasal continuous positive airway pressure of 6 cmH2O were eligible for MIST. Surfactant (160-240 mg/kg) was administered in supine position in 1-3 minutes via an umbilical catheter placed 2 cm below the vocal cords. Changes in end-expiratory lung volume (EELV), tidal volume, and its distribution were recorded continuously with electrical impedance tomography before and up to 60 minutes after MIST. Changes in transcutaneous oxygen saturation (SpO2) and partial carbon dioxide pressure, FiO2, respiratory rate, and minute ventilation were recorded. RESULTS A total of 16 preterm infants were included. One patient did not finish study protocol because of severe apnea 10 minutes after MIST. In the remaining infants (gestational age 29.8 ± 2.8 weeks, body weight 1545 ± 481 g) EELV showed a rapid and sustained increase, starting in the dependent lung regions, followed by the nondependent regions approximately 5 minutes later. Oxygenation, expressed as the SpO2/FiO2 ratio, increased from 233 (IQR 206-257) to 418 (IQR 356-446) after 60 minutes (P < .001). This change was significantly correlated with the change in EELV (ρ = 0.70, P < .01). Tidal volume and minute volume decreased significantly after MIST, but transcutaneous partial carbon dioxide pressure was comparable with pre-MIST values. Ventilation distribution remained unchanged. CONCLUSIONS MIST results in a rapid and homogeneous increase in EELV, which is associated with an improvement in oxygenation.
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Affiliation(s)
- Pauline S van der Burg
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Inez Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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21
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van der Burg PS, de Jongh FH, Miedema M, Frerichs I, van Kaam AH. The effect of prolonged lateral positioning during routine care on regional lung volume changes in preterm infants. Pediatr Pulmonol 2016; 51:280-5. [PMID: 26291607 DOI: 10.1002/ppul.23254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/04/2015] [Accepted: 07/03/2015] [Indexed: 11/10/2022]
Abstract
INTRODUCTION During routine nursing care, preterm infants are often placed in lateral position for several hours, but the effect of this procedure on regional lung volume and ventilation is unknown. In our study we examined this effect during 3 hrs of lateral positioning in stable preterm infants. METHODS Preterm infants on non-invasive respiratory support were eligible for the study. Infants were placed in supine position and subsequently transferred to right or left lateral position, according to their individual routine nursing schedule. Changes in end-expiratory lung volume (EELV), tidal volume (VT ) and ventilation distribution were recorded using electrical impedance tomography (EIT), starting 10 min before and up to 180 min after the positional change. Additionally, oxygen requirement, transcutaneous oxygen saturation and respiratory rate were recorded. RESULTS 15 infants were included (GA 28.9 ± 2.0 wk, BW 1167 ± 290 g). EELV increased significantly after changing to lateral position, stabilizing at a median value of 40.8 (IQR 29.0-99.3) AU/kg at 30 min. This increase could almost be exclusively attributed to the non-dependent lung regions. Tidal volume, oxygenation, and respiratory rate remained stable. Changing to the right, but not the left, lateral position resulted in a rapid but transient shift in ventilation to the dependent lung regions. After 180 min there were no differences in ventilation distribution between lateral and supine positioning. CONCLUSION This study shows that lateral position up to 3 hours, as part of normal nursing care of preterm infants, has no adverse effects on lung volumes and its regional distribution.
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Affiliation(s)
- Pauline S van der Burg
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Frans H de Jongh
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Inez Frerichs
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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22
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van der Burg PS, Miedema M, de Jongh FH, van Kaam AH. Unilateral atelectasis in a preterm infant monitored with electrical impedance tomography: a case report. Eur J Pediatr 2014; 173:1715-7. [PMID: 25146419 DOI: 10.1007/s00431-014-2399-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/05/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Electrical impedance tomography (EIT) is a non-invasive, radiation-free tool to monitor regional changes in ventilation. This report describes, for the first time, that unilateral atelectasis in an extremely low birth weight infant results in a loss of regional ventilation measured by EIT in the affected lung. CONCLUSION EIT is currently the most promising technique to monitor regional lung aeration continuously at the bedside in this vulnerable population.
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Affiliation(s)
- P S van der Burg
- Department of Neonatology, Emma Children's Hospital AMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands,
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23
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Onland W, Debray TP, Laughon MM, Miedema M, Cools F, Askie LM, Asselin JM, Calvert SA, Courtney SE, Dani C, Durand DJ, Marlow N, Peacock JL, Pillow JJ, Soll RF, Thome UH, Truffert P, Schreiber MD, Van Reempts P, Vendettuoli V, Vento G, van Kaam AH, Moons KG, Offringa M. Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study. BMC Pediatr 2013; 13:207. [PMID: 24345305 PMCID: PMC3878731 DOI: 10.1186/1471-2431-13-207] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 12/12/2013] [Indexed: 01/17/2023] Open
Abstract
Background Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Very different models using clinical parameters at an early postnatal age to predict BPD have been developed with little extensive quantitative validation. The objective of this study is to review and validate clinical prediction models for BPD. Methods We searched the main electronic databases and abstracts from annual meetings. The STROBE instrument was used to assess the methodological quality. External validation of the retrieved models was performed using an individual patient dataset of 3229 patients at risk for BPD. Receiver operating characteristic curves were used to assess discrimination for each model by calculating the area under the curve (AUC). Calibration was assessed for the best discriminating models by visually comparing predicted and observed BPD probabilities. Results We identified 26 clinical prediction models for BPD. Although the STROBE instrument judged the quality from moderate to excellent, only four models utilised external validation and none presented calibration of the predictive value. For 19 prediction models with variables matched to our dataset, the AUCs ranged from 0.50 to 0.76 for the outcome BPD. Only two of the five best discriminating models showed good calibration. Conclusions External validation demonstrates that, except for two promising models, most existing clinical prediction models are poor to moderate predictors for BPD. To improve the predictive accuracy and identify preterm infants for future intervention studies aiming to reduce the risk of BPD, additional variables are required. Subsequently, that model should be externally validated using a proper impact analysis before its clinical implementation.
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Affiliation(s)
- Wes Onland
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands.
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Miedema M, van der Burg PS, Beuger S, de Jongh FH, Frerichs I, van Kaam AH. Effect of nasal continuous and biphasic positive airway pressure on lung volume in preterm infants. J Pediatr 2013; 162:691-7. [PMID: 23102792 DOI: 10.1016/j.jpeds.2012.09.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/19/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To monitor regional changes in end-expiratory lung volume (EELV), tidal volumes, and their ventilation distribution during different levels of nasal continuous positive airway pressure (nCPAP) and nasal biphasic positive airway pressure (BiPAP) in stable preterm infants. STUDY DESIGN By using electrical impedance tomography and respiratory inductive plethysmography, we measured changes in EELV and tidal volumes in 22 preterm infants (gestational age 29.7 ± 1.5 weeks) during 3 nCPAP levels (2, 4, and 6 cmH2O) and unsynchronized BiPAP (nCPAP = 6 cmH2O; pressure amplitude = 3 cmH2O; frequency = 50/min; inspiration time = 0.5 seconds) at 10-minute intervals. We assessed the distribution of these volumes in ventral and dorsal chest regions by using electrical impedance tomography. RESULTS EELV increased with increasing nCPAP with no difference between the ventral and dorsal lung regions. Tidal volume also increased, and a decrease in phase angle and respiratory rate was noted by respiratory induction plethysmography. At the regional level, electrical impedance tomography data showed a more dorsally oriented ventilation distribution. BiPAP resulted in a small increase in EELV but without changes in tidal volume or its regional distribution. CONCLUSION Increasing nCPAP in the range of 2 to 6 cmH2O results in a homogeneous increase in EELV and an increase in tidal volume in preterm infants with a more physiologic ventilation distribution. Unsynchronized BiPAP does not improve tidal volume compared with nCPAP.
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Affiliation(s)
- Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Miedema M, de Jongh FH, Frerichs I, van Veenendaal MB, van Kaam AH. The effect of airway pressure and oscillation amplitude on ventilation in pre-term infants. Eur Respir J 2012; 40:479-84. [DOI: 10.1183/09031936.00138311] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Miedema M, de Jongh FH, Frerichs I, van Veenendaal MB, van Kaam AH. Regional respiratory time constants during lung recruitment in high-frequency oscillatory ventilated preterm infants. Intensive Care Med 2011; 38:294-9. [PMID: 22124769 PMCID: PMC3264882 DOI: 10.1007/s00134-011-2410-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 10/12/2011] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess the regional respiratory time constants of lung volume changes during stepwise lung recruitment before and after surfactant treatment in high-frequency oscillatory ventilated preterm infants. METHODS A stepwise oxygenation-guided recruitment procedure was performed before and after surfactant treatment in high-frequency oscillatory ventilated preterm infants. Electrical impedance tomography was used to continuously record changes in lung volume during the recruitment maneuver. Time constants were determined for all incremental and decremental pressure steps, using one-phase exponential decay curve fitting. Data were analyzed for the whole cross section of the chest and the ventral and dorsal lung regions separately. RESULTS Before surfactant treatment, the time constants of the incremental pressure steps were significantly longer (median 27.3 s) than those in the decremental steps (16.1 s). Regional analysis showed only small differences between the ventral and dorsal lung regions. Following surfactant treatment, the time constants during decremental pressure steps almost tripled to 44.3 s. Furthermore, the time constants became significantly (p < 0.01) longer in the dorsal (61.2 s) than into the ventral (40.3 s) lung region. CONCLUSIONS Lung volume stabilization during stepwise oxygenation-guided lung recruitment in high-frequency oscillatory ventilated preterm infants with respiratory distress syndrome is usually completed within 5 min and is dependent on the position of ventilation on the pressure volume curve, the surfactant status, and the region of interest of the lung.
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Affiliation(s)
- Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, P.O. Box 22660, Amsterdam 1100 DD, The Netherlands.
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Miedema M, de Jongh FH, Frerichs I, van Veenendaal MB, van Kaam AH. Changes in lung volume and ventilation during lung recruitment in high-frequency ventilated preterm infants with respiratory distress syndrome. J Pediatr 2011; 159:199-205.e2. [PMID: 21414632 DOI: 10.1016/j.jpeds.2011.01.066] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 01/05/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To assess global and regional changes in lung volume and ventilation during lung recruitment in preterm infants with respiratory distress syndrome. STUDY DESIGN Using electrical impedance tomography, changes in lung volume and ventilation were measured in 15 high-frequency oscillatory ventilated preterm infants during oxygenation-guided recruitment maneuvers. The inflation and deflation limbs were mapped, and the lower and upper inflection points were calculated using both oxygenation and impedance data. The impedance data were also used to determine recruitment-related changes in oscillation volume and distribution. RESULTS During inflation, lower and upper inflection points were identified in the majority of infants. The deflation limb showed clear lung hysteresis in all infants. The upper inflection point was significantly lower when comparing the pressure/oxygenation and pressure/impedance curves. Lung volume changes differed between the ventral and dorsal regions, but did not show a consistent pattern. Optimal recruitment increased the oscillation volume, but the distribution of ventilation was relatively homogeneous along the ventral-dorsal axis. CONCLUSIONS Lung hysteresis is present in preterm infants with respiratory distress syndrome. Regional differences in lung volume changes and ventilation during high-frequency oscillatory ventilation with lung recruitment are relatively modest and do not follow a gravity-dependent distribution.
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Affiliation(s)
- Martijn Miedema
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Miedema M, de Jongh FH, Frerichs I, van Veenendaal MB, van Kaam AH. Changes in Lung Volume and Ventilation during Surfactant Treatment in Ventilated Preterm Infants. Am J Respir Crit Care Med 2011; 184:100-5. [DOI: 10.1164/rccm.201103-0375oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Miedema M, Frerichs I, de Jongh FHC, van Veenendaal MB, van Kaam AH. Pneumothorax in a preterm infant monitored by electrical impedance tomography: a case report. Neonatology 2011; 99:10-3. [PMID: 20588065 DOI: 10.1159/000292626] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 02/16/2010] [Indexed: 11/19/2022]
Abstract
Electrical impedance tomography (EIT) is a noninvasive bedside tool for monitoring regional changes in ventilation. We report, for the first time, the EIT images of a ventilated preterm infant with a unilateral pneumothorax, showing a loss of regional ventilation in the affected lung during both high-frequency oscillation and spontaneous ventilation.
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Affiliation(s)
- M Miedema
- Department of Neonatology, Emma Children's Hospital AMC, Amsterdam, The Netherlands
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Robbers-Visser D, Miedema M, Nijveld A, Boersma E, Bogers AJ, Haas F, Helbing WA, Kapusta L. Results of staged total cavopulmonary connection for functionally univentricular hearts; comparison of intra-atrial lateral tunnel and extracardiac conduit. Eur J Cardiothorac Surg 2010; 37:934-41. [DOI: 10.1016/j.ejcts.2009.10.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 10/07/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022] Open
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Safwat A, Bissada N, Kumar U, Greene G, Madi R, Miedema M. MP-08.09: Laparoscopic Partial Nephrectomy Versus Laparoscopic Renal Cryoablation: Comparison of Operative and Oncologic Outcome. Urology 2009. [DOI: 10.1016/j.urology.2009.07.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Safwat A, Bissada N, Kumar U, Madi R, Miedema M. POD-06.08: Transperitoneal Versus Retroperitoneal Laparoscopic Radical Nephrectomy: Comparison of Operative and Postoperative Course and Outcome. Urology 2009. [DOI: 10.1016/j.urology.2009.07.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van Veenendaal MB, Miedema M, de Jongh FHC, van der Lee JH, Frerichs I, van Kaam AH. Effect of closed endotracheal suction in high-frequency ventilated premature infants measured with electrical impedance tomography. Intensive Care Med 2009; 35:2130-4. [PMID: 19774364 PMCID: PMC2779442 DOI: 10.1007/s00134-009-1663-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 09/07/2009] [Indexed: 11/04/2022]
Abstract
Objective To determine the global and regional changes in lung volume during and after closed endotracheal tube (ETT) suction in high-frequency ventilated preterm infants with respiratory distress syndrome (RDS). Design Prospective observational clinical study. Setting Neonatal intensive care unit. Patients Eleven non-muscle relaxed preterm infants with RDS ventilated with open lung high-frequency ventilation (HFV). Interventions Closed ETT suction. Measurements and results Changes in global and regional lung volume were measured with electrical impedance tomography. ETT suction resulted in an acute loss of lung volume followed by spontaneous recovery with a median residual loss of 3.3% of the maximum volume loss. The median stabilization time was 8 s. At the regional level, the lung volume changes during and after ETT suction were heterogeneous in nature. Conclusions Closed ETT suction causes an acute, transient and heterogeneous loss of lung volume in premature infants with RDS treated with open lung HFV.
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Affiliation(s)
- Mariëtte B van Veenendaal
- Department of Neonatology (H3-144), Emma Children's Hospital AMC, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Abstract
Patients with a long stay in the intensive care unit because of chronic critical illness consume many resources, and yet their outcome may be poor. We evaluated the long-term outcome of patients spending more than 60 days in the intensive care unit. We performed a retrospective cohort and prospective follow-up study of 78 patients staying more than 60 days in the 19-26 bed mixed intensive care unit of a university hospital from November 1995 to January 2003. The mortality in the intensive care unit was 38%; at 1 and 5 years it was 56% and 67%, respectively. Advanced age, prior pulmonary disease, long duration of renal replacement therapy, a low oxygenation ratio and platelet count and high Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores on day 60 influenced long-term mortality. A Simplified Acute Physiology Score II of 50 or a Sequential Organ Failure Assessment score of 8 or higher was associated with 100% mortality during follow-up. The overall 5-year survival rate of 33% suggests that prolonged intensive care may be worth the effort in certain patients.
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Affiliation(s)
- J Venker
- Department of Intensive Care, Institute for Cardiovascular Research, Free University Medical Center, Amsterdam, the Netherlands
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Hoogenraad CC, Koekkoek B, Akhmanova A, Krugers H, Dortland B, Miedema M, van Alphen A, Kistler WM, Jaegle M, Koutsourakis M, Camp NV, Verhoye M, van der Linden A, Kaverina I, Grosveld F, Zeeuw CID, Galjart N. Erratum: Targeted mutation of Cyln2 in the Williams syndrome critical region links CLIP-115 haploinsufficiency to neurodevelopmental abnormalities in mice. Nat Genet 2002. [DOI: 10.1038/ng1002-331c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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