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Background Morbid obesity predisposes patients to lung collapse and hypoxemia during induction of anaesthesia. The aim of this prospective study was to determine whether noninvasive positive pressure ventilation (NPPV) improves arterial oxygenation and end-expiratory lung volume (EELV) compared with conventional preoxygenation, and whether NPPV followed by early recruitment manoeuvre (RM) after endotracheal intubation (ETI) further improves oxygenation and respiratory function compared with NPPV alone. Methods 24 patients with higher lever intra-abdominal pressure (15,2 ± 2,4 cm H 2 O) were randomised to receive 5 min of either conventional preoxygenation with spontaneous breathing of 100% O 2 (CON), NPPV (pressure support and positive end-expiratory pressure), or NPPV followed by RM (NPPV+RM). Gas exchange was measured in awake patients, at the end of preoxygenation, immediately after ETI, and 5 min after the onset of mechanical ventilation. EELV was measured immediately after ETI and 5 min after mechanical ventilation. The primary endpoint was arterial oxygenation 5 min after the onset of mechanical ventilation. Intra-abdominal pressure (IAP) was controlled by Cron Results are presented as mean ± SD. Results At the end of preoxygenation, PaO 2 was higher in the NPPV and NPPV+RM groups (382 ± 68 mmHg and 362 ± 71 mmHg, respectively; both p 2 was90 ± 28 mmHg in the CON group, 118 ± 48 mmHg in the NPPV group (p = 0.035 vs. CON group), and 211 ± 59 mmHg in the NPPV+RM group (p 2 obtained 5 min after mechanical ventilation and EELV (R = 0.41, p Conclusion NPPV improves oxygenation and EELV in children with higher lever intra-abdominal pressure compared with conventional preoxygenation. NPPV combined with early RM is more effective than NPPV alone at improving respiratory function after ETI.

Objective Increased pulmonary vascular resistance in low birth newborn with omphalocele is suggested, and endothelin-1 plays an important role in pulmonary vascular reactivity in newborns. Methods We determined plasma (second sample) levels of endothelin-1 in 12 low birth newborns with omphalocele and 14 without omphalocele (gestational ages: 26.2±1.4 and 25.4±1.6 weeks, respectively). Blood and a second blood sample taken 18 to 40 h after birth were used for endothelin-1 determination by enzyme immunoassay. Result Plasma levers ET-1 concentrations were higher than second sample ET-1 levels in both groups (p Conclusion Our low birth newborn with and without omphalocele had similar plasma ET-1 levels, whereas ET-1 levels were higher in omphalocele than in control newborns 18 to 40 h after birth. The increased vascular resistance in omphalocele may be related to high ET-1 levels.

Objective To assess the relationship between concentrations of bronchoalveolar cytokines and bacterial burden (quantitative bacterial count) in long term mechanical ventilation newborn with a presumptive diagnosis of ventilator-associated pneumonia. Interventions According to the time course of ventilator-associated pneumonia at the time of study with bronchoalveolar lavage, 44 newborn were divided into two subgroups: referral (n=18), and treated (n=26) ventilator-associated pneumonia. Bronchoalveolar lavage was performed in the most abnormal area on chest radiograph by fiberoptic bronchoscope. Bronchoalveolar lavage fluid was processed for quantitative bacterial culture. The concentrations of bronchoalveolar lavage cytokines (tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6) also were measured. Measurements and Main Results 26 patients had a positive bacterial culture (bronchoalveolar lavage > or = 10 colony-forming units/mL), and made up 79% of pathogens recovered at high concentrations. The concentrations of bronchoalveolar lavage interleukin-1 beta were 200.4 +/- 22.4 and 44.8 +/- 14.2 pg/mL (mean +/- se) in the newborn with positive and negative bacterial culture, respectively (p Conclusions Since the concentration of bronchoalveolar lavage interleukin-1 beta was correlated with bacterial burden in the alveoli, it may be a marker for progressive and ongoing inflammation in long term mechanical ventilation newborn.