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3 results on '"GERHARDT, TILO"'

1. Effects of volume-guaranteed synchronized intermittent mandatory ventilation in preterm infants recovering from respiratory failure

Author

Herrera, Carmen M., Gerhardt, Tilo, Claure, Nelson, Everett, Ruth, Musante, Gabriel, Thomas, Carlos, and Bancalari, Eduardo

Subjects
Respiratory insufficiency in children -- Care and treatment, Birth weight, Low -- Physiological aspects, Positive pressure respiration -- Evaluation, Infants (Newborn) -- Care and treatment
Abstract

Objective. Volume guarantee (synchronized intermittent mandatory ventilation [SIMV]+VG) is a novel mode of SIMV for automatic adjustment of the peak inspiratory pressure to ensure a minimum set mechanical tidal volume ([V.sub.T mech]), The objective of this study was to compare the effects of SIMV+VG with conventional SIMV on ventilation and gas exchange in a group of very low birth weight infants recovering from acute respiratory failure. Methods. Nine infants were initially studied during 2 consecutive 60-minute ventilatory modalities of conventional SIMV (ventilator settings by clinical team) and SIMV+VG 4.5 ([V.sub.T mech] set at 4.5 mL/kg) in random order. Eight additional infants were studied during the same ventilatory modalities plus 1 additional epoch consisting of SIMV+VG 3.0 ([V.sub.T mech] set at 3.0 mL/kg). Results. Peak inspiratory pressure was significantly lower during SIMV+VG 3.0. Mean airway pressure, [V.sub.T mech], number of large [V.sub.T mech] (>7 mL/kg), and mechanical minute ventilation ([V'.sub.E]) were reduced during SIMV+VG 4.5 compared with SIMV and were further reduced during SIMV+VG 3.0. Spontaneous [V'.sub.E] increased during SIMV+VG 4.5 and was even higher during SIMV+VG 3.0. The resulting total [ V'.sub.E] was higher during both SIMV+VG modes compared with SIMV. Arterial oxygen saturation by pulse oximetry, transcutaneous carbon dioxide tension, and fraction of inspired oxygen did not differ significantly, although transcutaneous carbon dioxide tension increased slightly during SIMV+VG 3.0. Conclusions. The short-term use of SIMV+VG resulted in automatic weaning of the mechanical support and enhancement of the spontaneous respiratory effort while maintaining gas exchange relatively unchanged in comparison to conventional SIMV. Pediatrics 2002;110: 529-533; mechanical ventilation, patient triggered ventilation, weaning., ABBREVIATIONS. VLBW, very low birth weight; SIMV, synchronized intermittent mandatory ventilation; PIP, peak inspiratory pressure; VG, volume guarantee ventilation; [V.sub.T mech], mechanical tidal volume; PEEP, positive end-expiratory pressure; FI[O.sub.2], fraction [...]

Published
2002

2. Closed-Loop Controlled Inspired Oxygen Concentration for Mechanically Ventilated Very Low Birth Weight Infants With Frequent Episodes of Hypoxemia

Author

Claure, Nelson, Gerhardt, Tilo, Everett, Ruth, Musante, Gabriel, Herrera, Carmen, and Bancalari, Eduardo

Subjects
Hypoxia -- Prevention, Infants (Premature) -- Care and treatment, Oxygen therapy -- Technology application
Abstract

Background. Mechanically ventilated very low birth weight infants often present with frequent episodes of hypoxemia, and maintaining arterial oxygen saturation by pulse oximetry (Sp[O.sub.2]) within a normal range by manual fraction of inspired oxygen ([FIO.sub.2]) adjustments is difficult and time consuming. Objectives. An algorithm for closed-loop [FIO.sub.2] control (c[FIO.sub.2]) to maintain Sp[O.sub.2] within a target range was compared with continuous manual [FIO.sub.2] (m[FIO.sub.2]) adjustments by a nurse in a group of ventilated infants who presented with frequent episodes of hypoxemia. Results. Fourteen infants (birth weight: 712 [+ or -] 142 g; gestational age: 25 [+ or -] 1.6 weeks; age: 26 [+ or -] 11 days; synchronized intermittent mandatory ventilation rate: 24 [+ or -] 10 b/m; peak inspiratory pressure: 17.5 [+ or -] 2.0 cm[H.sub.2]O; positive end-expiratory pressure: 4.3 [+ or -] 0.5 cm[H.sub.2]O) were studied for 2 hours on each mode in random sequence. Both modes aimed to maintain Sp[O.sub.2] between 88% and 96%. There were 15 [+ or -] 7 and 16 [+ or -] 6 hypoxemic episodes/hour (Sp[O.sub.2] [is less than] 88%, [is greater than] 5 s) during m[FIO.sub.2] and c[FIO.sub.2] respectively; episode duration was 41 [+ or -] 23 and 32 [+ or -] 15 s, totaling 19 [+ or -] 16% and 17 [+ or -] 12% of recording time. There were 13 [+ or -] 10 and 10 [+ or -] 8 hyperoxemic episodes/hour (Sp[O.sub.2] [is greater than] 96%, [is greater than] 5 s) during m[FIO.sub.2] and c[FIO.sub.2], respectively; episode duration was 27 [+ or -] 15 and 24 [+ or -] 19 s, totaling 15 [+ or -] 14% and 10 [+ or -] 9% of recording time. Mean Sp[O.sub.2] and [FIO.sub.2] levels were similar during both modes. The nurse made 29 [+ or -] 17 adjustments/hour during m[FIO.sub.2]. There was a significant increase in the duration of normoxemia (Sp[O.sub.2] between 88%-96%) during c[FIO.sub.2] (75 [+ or -] 13 vs 66 [+ or -] 14% of recording time). Conclusion. In this group of infants, c[FIO.sub.2] was at least as effective as a fully dedicated nurse in maintaining Sp[O.sub.2] within the target range, and it may he more effective than a nurse working under routine conditions. We speculate that during long-term use, c[FIO.sub.2] may save nursing time and reduce the risks of morbidity associated with supplemental oxygen and episodes of hypo- and hyperoxemia. Pediatrics 2001;107:1120-1124; hypoxemic episodes, preterm infant, mechanical ventilation, [FIO.sub.2], automatic [FIO.sub.2] adjustment, closed-loop [FIO.sub.2] control., ABBREVIATIONS. VLBW, very low birth weight; Sp[O.sub.2], arterial oxygen saturation by pulse oximetry; [FIO.sub.2], fraction of inspired oxygen; c[FIO.sub.2], closed-loop [FIO.sub.2] control mode; m[FIO.sub.2], manual [FIO.sub.2] control mode. Very low [...]

Published
2001

3. Respiratory instability in neonates with in utero exposure to cocaine

Author

Chen, Cindy, Duara, Shahnaz, Neto, Galdino Silva, Tan, Sidhartha, Bandstra, Emmalee S., Gerhardt, Tilo, and Bancalari, Eduardo

Subjects
Respiration, Infants (Newborn) -- Physiological aspects, Cocaine -- Physiological aspects, Prenatal influences -- Physiological aspects, Health
Abstract

To learn more concerning the effects of prenatal cocaine exposure on the respiratory system, 21 apparently healthy newborn infants whose mothers had used cocaine during pregnancy were studied. A control group of 10 newborns whose mothers had no histories of drug use were also examined. Healthy newborns temporarily stop breathing as a reflex when a stream of air is directed at their faces, whereas premature infants pause in their breathing more often after such stimulation. The cocaine-exposed infants (average age, between four and five days) were tested in this way while physiological variables were monitored. The number and length of breathing pauses elicited by the airstream were noted. The infants also breathed air containing higher concentrations of carbon dioxide than normal (4 percent carbon dioxide for a three to five minute period) while heart and breathing rates were measured. Results showed that respiratory pauses were much more common among cocaine-exposed babies than controls and that the pauses lasted longer among the former group. No differences were observed between the groups in their responses to the increased levels of carbon dioxide. The results show that respiratory instability, although not obvious, is present in infants exposed to cocaine in utero. (Consumer Summary produced by Reliance Medical Information, Inc.)

Published
1991

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