BOOK
Assisted Ventilation of the Neonate E-Book
Jay P. Goldsmith | Edward Karotkin | Gautham Suresh | Martin Keszler
(2016)
Additional Information
Book Details
Abstract
Extensively updated and featuring a new editorial team, the 6th Edition of Assisted Ventilation of the Neonate, by Drs. Jay P. Goldsmith, Edward Karotkin, Gautham Suresh, and Martin Keszler, continues to be a must-have reference for the entire NICU. Still the only fully comprehensive guide in this fast-changing area, it provides expert guidance on contemporary management of neonatal respiratory diseases, with an emphasis on evidence-based pharmacologic and technologic advances to improve outcomes and quality of life in newborns. A new full-color design and chapter layout combine for quick and easy reference.
- Covers everything you need to know about respiratory management in neonates: general principles and concepts; assessment, diagnosis and monitoring methods; therapeutic respiratory interventions; adjunctive interventions; and special situations and outcomes.
- Covers basic concepts of pulmonary pathophysiology and gives practical guidance on providing neonatal respiratory support with a variety of techniques, so you can learn both basic and advanced methods in one volume.
- Offers more than 30 appendices that help you quickly find normal values, assessment charts, ICU flow charts, procedure steps and other useful, printable forms.
- Reflects the rapid evolution of approaches to respiratory care, including the shift to non-invasive support, as well as changes in oxygenation targets, high-flow nasal therapy, volume ventilation, and sophisticated microprocessor-controlled ventilators.
- Completely new information on many previously covered topics, including ethical and legal issues related to neonatal mechanical ventilation.
- Features 11 entirely new chapters, including Radiography, Lung Ultrasound and Other Imaging Modalities; Non-invasive Monitoring of Gas Exchange; Airway Evaluation: Bronchoscopy, Laryngoscopy, Tracheal Aspirates; Special Ventilation Techniques; Cardiovascular Therapy and PPHN; and Quality Improvement in Respiratory Care .
- Includes new opening summaries that highlight key information in each chapter.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC\r | ES1 | ||
| ASSISTED VENTILATION OF THE NEONATE: AN EVIDENCE-BASED\rAPPROACH TO NEWBORN RESPIRATORY CARE\r | i | ||
| ASSISTED VENTILATION OF THE NEONATE: AN EVIDENCE-BASED\rAPPROACH TO NEWBORN RESPIRATORY CARE\r | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| CONTRIBUTORS | vi | ||
| FOREWORD | xi | ||
| PREFACE | xii | ||
| CONTENTS | xiii | ||
| I - History, Pulmonary Physiology, and General Considerations | 1 | ||
| 1 - Introduction and Historical Aspects | 1 | ||
| HISTORY OF NEONATAL VENTILATION: EARLIEST REPORTS | 1 | ||
| SIXTEENTH AND SEVENTEENTH CENTURIES | 2 | ||
| NINETEENTH CENTURY | 2 | ||
| TWENTIETH CENTURY | 3 | ||
| BREAKTHROUGHS IN VENTILATION | 5 | ||
| RECENT ADVANCES AND OUTCOMES | 7 | ||
| REFERENCES | 7 | ||
| REFERENCES | 7.e1 | ||
| 2 - Physiologic Principles* | 8 | ||
| BASIC BIOCHEMISTRY OF RESPIRATION: OXYGEN AND ENERGY | 8 | ||
| ONTOGENY RECAPITULATES PHYLOGENY: A BRIEF OVERVIEW OF DEVELOPMENTAL ANATOMY | 9 | ||
| Lung Development | 9 | ||
| Phases of Lung Development | 9 | ||
| Embryonic Phase (Weeks 3 to 6): Development of Proximal Airways | 9 | ||
| Pseudoglandular Phase (Weeks 6 to 16): Development of Lower Conducting Airways | 9 | ||
| Canalicular Phase (Weeks 16 to 26): Formation of Gas-Exchanging Units or Acini | 9 | ||
| Terminal Sac Phase (Weeks 26 to 36): Refinement of Acini | 9 | ||
| Alveolar Phase (Week 36 to 3Years): Alveolar Proliferation and Development | 9 | ||
| MECHANICS | 9 | ||
| Compliance | 13 | ||
| Static Compliance | 13 | ||
| Dynamic Compliance | 13 | ||
| Resistance | 15 | ||
| Flow Rate | 15 | ||
| Airway or Tube Length | 15 | ||
| Airway or Tube Diameter | 16 | ||
| Viscosity and Density | 16 | ||
| Work of Breathing | 16 | ||
| Time Constant | 17 | ||
| GAS TRANSPORT | 18 | ||
| Mechanisms of Gas Transport | 18 | ||
| OXYGENATION | 21 | ||
| Effects of Altering Ventilator Settings on Oxygenation | 23 | ||
| VENTILATION | 24 | ||
| Effects of Altering Ventilator Settings on Ventilation | 26 | ||
| PERFUSION | 26 | ||
| CONTROL OF VENTILATION | 30 | ||
| CONCLUSION | 30 | ||
| REFERENCES | 30 | ||
| REFERENCES | 30.e1 | ||
| 3 - Control of Ventilation | 31 | ||
| INTRODUCTION | 31 | ||
| PATHOGENESIS OF APNEA OF PREMATURITY | 31 | ||
| Central (CO2) Chemosensitivity | 31 | ||
| Peripheral (Hypoxic) Chemosensitivity | 31 | ||
| Role of Mechanoreceptor (Laryngeal) Afferents | 32 | ||
| GENESIS OF CENTRAL, MIXED, AND OBSTRUCTIVE APNEA | 32 | ||
| RELATIONSHIP BETWEEN APNEA, BRADYCARDIA, AND DESATURATION | 32 | ||
| CARDIORESPIRATORY EVENTS IN INTUBATED INFANTS | 32 | ||
| THERAPEUTIC APPROACHES | 33 | ||
| Optimization of Mechanosensory Inputs | 33 | ||
| Optimization of Blood Gas Status | 33 | ||
| Role of Gastroesophageal Reflux | 33 | ||
| Xanthine Therapy | 34 | ||
| Continuous Positive Airway Pressure | 34 | ||
| LONGER TERM CONSEQUENCES OF NEONATAL APNEA | 35 | ||
| REFERENCES | 35 | ||
| REFERENCES | 35.e1 | ||
| 4 - Ethical Issues in Assisted Ventilation of the Neonate | 36 | ||
| INTRODUCTION | 36 | ||
| HISTORICAL BACKGROUND | 37 | ||
| Initiating Ventilator Support | 37 | ||
| Withdrawal (Nonescalation) of Ventilator Support | 37 | ||
| Quality of Life | 37 | ||
| Medical Futility | 38 | ||
| Are These Debates Resolvable? | 39 | ||
| Chronic Ventilation | 39 | ||
| Appropriate Care after Withdrawal of Life Support | 39 | ||
| CONCLUSION | 40 | ||
| REFERENCES | 40 | ||
| REFERENCES | 40.e1 | ||
| 5 - Evidence-Based Respiratory Care | 41 | ||
| BACKGROUND | 41 | ||
| THE TECHNICAL STEPS OF EBM | 41 | ||
| Formulating the Question | 41 | ||
| Searching for the Evidence | 41 | ||
| Evaluating Evidence about Therapy | 42 | ||
| Evaluating the Quality of Evidence | 42 | ||
| Determining the Quantitative Effects of a Therapy | 43 | ||
| Systematic Reviews of Therapeutic Interventions and Meta-analyses | 45 | ||
| Weighing Risks, Benefits, and Costs | 45 | ||
| Evaluating Evidence about Diagnostic Tests | 45 | ||
| Evaluating the Quality of Evidence for Diagnostic Tests | 45 | ||
| Determining Diagnostic Test Accuracy | 46 | ||
| Bayesian Reasoning in Diagnostic Testing | 46 | ||
| Special Considerations in Applying Evidence to Respiratory Interventions | 47 | ||
| COGNITIVE SKILLS FOR EVIDENCE-BASED PRACTICE | 47 | ||
| Critical Thinking | 47 | ||
| Clinical Reasoning and Decision Making | 47 | ||
| TRANSLATING EVIDENCE INTO PRACTICE | 47 | ||
| SUMMARY | 48 | ||
| REFERENCES | 48 | ||
| REFERENCES | 48.e1 | ||
| 6 - Quality and Safety in Respiratory Care | 49 | ||
| QUALITY AND SAFETY: TERMINOLOGY AND FRAMEWORKS | 49 | ||
| Donabedian’s Triad | 49 | ||
| The Institute of Medicine’s Domains of Quality | 49 | ||
| ASSESSING AND MONITORING THE QUALITY OF CARE | 50 | ||
| QUALITY INDICATORS FOR COMPARATIVE PERFORMANCE MEASURES | 50 | ||
| QUALITY INDICATORS FOR IMPROVEMENT | 50 | ||
| IMPROVING THE QUALITY OF CARE | 51 | ||
| THE IMPROVEMENT TEAM | 51 | ||
| COLLABORATION | 51 | ||
| AIM: WHAT ARE WE TRYING TO ACCOMPLISH? | 51 | ||
| MEASUREMENT: HOW WILL WE KNOW THAT A CHANGE IS AN IMPROVEMENT? | 51 | ||
| WHAT CHANGES CAN WE MAKE THAT WILL RESULT IN AN IMPROVEMENT? | 52 | ||
| PLAN–DO–STUDY–ACT CYCLES | 52 | ||
| ENSURING THE SUCCESS OF QUALITY IMPROVEMENT PROJECTS | 53 | ||
| LEADERSHIP AND UNIT CULTURE | 54 | ||
| WHY IS QUALITY IMPROVEMENT IMPORTANT IN NEONATAL RESPIRATORY CARE? | 54 | ||
| EXAMPLES OF QUALITY AND SAFETY IMPROVEMENT IN NEONATAL RESPIRATORY CARE | 54 | ||
| Quality Improvement Projects in Individual Units | 54 | ||
| Collaborative Quality Improvement Projects | 54 | ||
| CONCLUSION | 55 | ||
| REFERENCES | 55 | ||
| REFERENCES | 55.e1 | ||
| 7 - Medical and Legal Aspects of Respiratory Care | 56 | ||
| DISCLAIMER | 56 | ||
| GENERAL LEGAL PRINCIPLES | 56 | ||
| SUPERVISION OF OTHERS | 56 | ||
| MALPRACTICE | 57 | ||
| Duty | 57 | ||
| Breach | 57 | ||
| The Expert Witness | 57 | ||
| Causation | 58 | ||
| Damages | 58 | ||
| Burden of Proof | 58 | ||
| MALPRACTICE ISSUES SPECIFIC TO NEONATOLOGY AND NEONATAL RESPIRATORY CARE | 58 | ||
| Resuscitation | 58 | ||
| Prematurity/Periventricular Leukomalacia | 58 | ||
| RESPIRATORY FAILURE/MECHANICAL VENTILATION | 59 | ||
| Patient Safety/Culture of Safety | 59 | ||
| DECREASING THE RISK OF A MALPRACTICE LAWSUIT | 59 | ||
| Competency | 59 | ||
| Communication | 59 | ||
| Documentation | 60 | ||
| THE FUTURE OF MALPRACTICE LITIGATION | 60 | ||
| CONCLUSION | 60 | ||
| REFERENCES | 60 | ||
| REFERENCES | 60.e1 | ||
| II - Patient Evaluation, and Monitoring | 61 | ||
| 8 - Physical Examination | 61 | ||
| HISTORICAL ASPECTS | 61 | ||
| IMPORTANCE OF THE PHYSICAL EXAMINATION | 61 | ||
| TECHNIQUE OF THE PHYSICAL EXAMINATION | 61 | ||
| Overview | 61 | ||
| Performing the Neonatal Respiratory Physical Examination | 61 | ||
| INTERPRETATION OF THE FINDINGS OF PHYSICAL EXAMINATION | 62 | ||
| General Physical Examination Findings | 62 | ||
| Special Technique of Examination: Transillumination | 63 | ||
| Examination at Birth | 63 | ||
| Examination of an Infant Receiving Face Mask or Laryngeal Mask Ventilation | 64 | ||
| Examination of a Ventilated Infant | 64 | ||
| . This section focuses on the essen | 64 | ||
| . A patient placed on high-frequency oscillatory ventilation (HFOV) may not breathe regularly, and auscultation of the chest may... | 64 | ||
| . A patient placed on the jet ventilator will have findings and interpretations similar to those on HFOV in terms of chest wiggl... | 65 | ||
| Examination of an Infant on CPAP | 65 | ||
| SUMMARY | 65 | ||
| REFERENCES | 66 | ||
| REFERENCES | 66.e1 | ||
| 9 - Imaging: Radiography, Lung Ultrasound, and Other Imaging Modalities | 67 | ||
| INTRODUCTION | 67 | ||
| RADIATION EXPOSURE | 67 | ||
| IMAGING MODALITIES | 67 | ||
| Chest Radiograph | 67 | ||
| Ultrasound | 68 | ||
| Computed Tomography | 68 | ||
| Fluoroscopy | 69 | ||
| Magnetic Resonance Imaging | 70 | ||
| INVASIVE SUPPORT DEVICES | 70 | ||
| COMMON ETIOLOGIES OF RESPIRATORY DISTRESS IN INFANTS | 71 | ||
| Respiratory Distress Syndrome | 71 | ||
| Transient Tachypnea of the Newborn | 72 | ||
| Meconium Aspiration Syndrome | 72 | ||
| Pneumonia | 73 | ||
| Air-Leak Syndromes | 74 | ||
| Pneumothorax | 74 | ||
| Pneumomediastinum | 74 | ||
| Pneumopericardium | 74 | ||
| Pulmonary Interstitial Emphysema | 75 | ||
| Pulmonary Hemorrhage | 75 | ||
| Pleural Effusion | 75 | ||
| Bronchopulmonary Dysplasia | 76 | ||
| CONGENITAL AND SURGICAL CAUSES OF RESPIRATORY DISTRESS | 76 | ||
| Congenital Lung Lesions | 76 | ||
| Pulmonary Agenesis, Aplasia, and Hypoplasia | 77 | ||
| Bronchial Atresia or Stenosis | 78 | ||
| Congenital Pulmonary Airway Malformation | 78 | ||
| Bronchopulmonary Sequestration | 78 | ||
| Congenital Lobar Emphysema | 78 | ||
| Congenital Diaphragmatic Hernia | 79 | ||
| REFERENCES | 79 | ||
| REFERENCES | 79.e2 | ||
| 10 - Blood Gases: Technical Aspects and Interpretation | 80 | ||
| BLOOD GAS PHYSIOLOGY | 80 | ||
| Oxygen Transport | 80 | ||
| Understanding the Oxyhemoglobin Dissociation Curve | 82 | ||
| Considerations Regarding Fetal Hemoglobin | 82 | ||
| Hypoxemia and Hypoxia | 83 | ||
| Carbon Dioxide Transport | 84 | ||
| Metabolic Acidosis | 84 | ||
| Metabolic Alkalosis | 84 | ||
| TECHNIQUES FOR OBTAINING BLOOD SAMPLES | 84 | ||
| Umbilical Artery Catheters | 84 | ||
| Subumbilical Cutdown | 86 | ||
| Complications of Umbilical Artery Catheterization | 86 | ||
| Other Indwelling Catheter Sites | 87 | ||
| Infusion of Fluids through Arterial Catheters | 88 | ||
| Arterial Puncture | 88 | ||
| Arterialized Capillary Blood | 88 | ||
| Continuous Invasive Monitoring | 89 | ||
| Noninvasive Estimation of Blood Gases | 89 | ||
| Pulse Oximetry | 89 | ||
| Transcutaneous Monitoring | 90 | ||
| Capnography | 91 | ||
| Near-Infrared Spectroscopy | 91 | ||
| CHOICE OF MONITORING METHODS | 91 | ||
| BLOOD GAS ANALYZERS | 92 | ||
| Measuring Principle of a Blood Gas Analyzer | 92 | ||
| Blood Gas Analyzer Quality Assurance | 92 | ||
| CLINICAL INTERPRETATION OF BLOOD GASES | 92 | ||
| COMPONENTS OF BLOOD GAS TESTING THAT ARE MEASURED DIRECTLY | 92 | ||
| pH | 92 | ||
| Carbon Dioxide | 94 | ||
| PaO2 | 94 | ||
| COMPONENTS OF BLOOD GAS TESTING THAT ARE NOT MEASURED DIRECTLY | 95 | ||
| Anchor 372 | 95 | ||
| Base Excess | 95 | ||
| Oxygen Saturation | 95 | ||
| Lactate | 95 | ||
| ERRORS IN BLOOD GAS MEASUREMENTS | 95 | ||
| ASSESSING THE ACCURACY OF A BLOOD GAS RESULT | 96 | ||
| FINAL THOUGHTS | 96 | ||
| ACKNOWLEDGEMENT | 96 | ||
| REFERENCES | 96 | ||
| REFERENCES | 96.e1 | ||
| 11 - Noninvasive Monitoring of Gas Exchange | 97 | ||
| NONINVASIVE MONITORING OF OXYGENATION | 97 | ||
| Pulse Oximetry | 97 | ||
| Indications for Pulse Oximetry | 99 | ||
| Delivery Room Resuscitation | 99 | ||
| Limitations of Pulse Oximetry | 101 | ||
| Functional vs Fractional Saturation | 101 | ||
| Additional Considerations | 101 | ||
| Transcutaneous Oxygen Monitoring | 102 | ||
| NONINVASIVE ASSESSMENT OF PACO2 | 102 | ||
| Capnography and End-Tidal CO2 Monitoring | 102 | ||
| Mainstream and Sidestream Capnography | 103 | ||
| CO2 Monitoring in the NICU | 103 | ||
| Capnography during Neonatal Anesthesia | 104 | ||
| Colorimetric CO2 Detectors | 104 | ||
| Optimizing Ventilation Settings with Capnography | 104 | ||
| Limitations of Capnography | 104 | ||
| Transcutaneous CO2 Monitoring | 104 | ||
| TISSUE OXYGEN SATURATION MONITORING USING NEAR-INFRARED SPECTROSCOPY | 105 | ||
| Normal Values | 106 | ||
| Application of Near-Infrared Spectroscopy in Newborns | 106 | ||
| Management of Hypotension | 106 | ||
| Patent Ductus Arteriosus | 106 | ||
| Cerebral Perfusion with Changes in Mean Airway Pressure and Ventilation | 107 | ||
| Mesenteric Ischemia and Risk of Necrotizing Enterocolitis | 107 | ||
| Limitations of Near-Infrared Spectroscopy | 107 | ||
| CONCLUSION | 107 | ||
| ACKNOWLEDGMENTS | 107 | ||
| REFERENCES | 107 | ||
| REFERENCES | 107.e1 | ||
| 12 - Pulmonary Function and Graphics* | 108 | ||
| TECHNICAL ASPECTS | 108 | ||
| Pneumotachometers | 108 | ||
| Alternative Sensors | 108 | ||
| Signal Calibration | 108 | ||
| RESPIRATORY PHYSIOLOGY AND PATHOPHYSIOLOGY | 109 | ||
| MEASUREMENTS DISPLAYED ONPULMONARY GRAPHICS | 110 | ||
| Pressure Measurement | 110 | ||
| Instrumentation for Pressure Measurement | 110 | ||
| Volume Measurement | 110 | ||
| Pulmonary Graphic Representation of Tidal Volume | 110 | ||
| Flow Measurement (Inspiratory and Expiratory Airflow) | 111 | ||
| Minute Ventilation | 111 | ||
| Pressure–Volume Curve | 111 | ||
| Pulmonary Mechanics | 112 | ||
| Lung Compliance | 112 | ||
| Dynamic Compliance | 112 | ||
| Resistive Properties | 112 | ||
| Synchronous and Asynchronous Breathing | 114 | ||
| ROLE OF PULMONARY GRAPHICS IN VENTILATOR MANAGEMENT | 114 | ||
| Optimizing Peak Inspiratory Pressure | 115 | ||
| Optimizing End-Expiratory Pressure | 115 | ||
| Optimizing Expiratory Airflow | 115 | ||
| Optimizing Inspiratory Time | 115 | ||
| Optimizing Synchrony and Rate of Ventilatory Support | 116 | ||
| Optimizing Tidal Volume | 116 | ||
| Optimizing Inspiratory Oxygen | 116 | ||
| Permissive Hypercarbia | 116 | ||
| LIMITATIONS OF BEDSIDE PULMONARY GRAPHICS | 116 | ||
| NEWER TECHNIQUES | 116 | ||
| SUMMARY | 117 | ||
| CAVEATS | 117 | ||
| REFERENCES | 117 | ||
| REFERENCES | 117.e1 | ||
| 13 - Airway Evaluation: Bronchoscopy, Laryngoscopy, and Tracheal Aspirates | 118 | ||
| INTRODUCTION | 118 | ||
| FLEXIBLE NASOPHARYNGOLARYNGOSCOPY IN THE NEONATE | 118 | ||
| Indications | 118 | ||
| Risks, Contraindications, and Limitations | 118 | ||
| Equipment | 118 | ||
| DIRECT MICROLARYNGOSCOPY AND RIGID BRONCHOSCOPY IN THE NEONATE | 119 | ||
| Indications | 119 | ||
| Risks, Contraindications, and Limitations | 121 | ||
| Equipment | 121 | ||
| FIBER-OPTIC FLEXIBLE BRONCHOSCOPY | 121 | ||
| Indications | 121 | ||
| Risks, Contraindications, and Limitations | 122 | ||
| Equipment | 123 | ||
| BRONCHOALVEOLAR LAVAGE AND TRACHEAL ASPIRATES | 123 | ||
| SUMMARY | 123 | ||
| REFERENCES | 123 | ||
| REFERENCES | 123.e1 | ||
| 14 - Cardiovascular Assessment | 124 | ||
| INTRODUCTION | 124 | ||
| CARDIOVASCULAR CARE IN THE DELIVERY ROOM | 124 | ||
| Transitional Cardiovascular Physiology | 124 | ||
| Delayed Cord Clamping | 124 | ||
| APPROACH TO THE CARE OF THE NEONATE WITH COMPROMISED OXYGENATION | 125 | ||
| Physiology | 125 | ||
| Pulmonary Hypertension | 125 | ||
| Persistent Pulmonary Hypertension of the Newborn | 125 | ||
| Chronic Pulmonary Hypertension | 125 | ||
| Clinical Assessment | 126 | ||
| Cyanotic Congenital Heart Disease versus PPHN | 126 | ||
| Management | 127 | ||
| Resuscitation and General Management | 128 | ||
| Specific Pulmonary Vasodilator Therapies and the Role of Targeted Neonatal Echocardiography | 128 | ||
| APPROACH TO THE INFANTS WITH COMPROMISED SYSTEMIC HEMODYNAMICS | 129 | ||
| Physiology | 129 | ||
| Clinical Evaluation | 131 | ||
| Role of Targeted Neonatal Echocardiography | 132 | ||
| Management | 133 | ||
| Systolic Hypotension | 133 | ||
| Diastolic Hypotension | 134 | ||
| APPROACH TO THE INFANT WITH PATENT DUCTUS ARTERIOSUS | 134 | ||
| Pathophysiologic Continuum of the Ductal Shunt in Neonates | 134 | ||
| Clinical Importance of the Patent Ductus Arteriosus | 134 | ||
| Determining the Hemodynamic Significance of the Ductus Arteriosus | 135 | ||
| Echocardiography | 135 | ||
| . A ductal diameter ≥1.5mm on the first day of life predicts a subsequently symptomatic PDA.58 The transductal flow pattern perm... | 135 | ||
| . Left-heart dimensions and output, pulmonary artery diastolic velocities, and transmitral Doppler flow patterns are surrogate e... | 136 | ||
| . Diastolic flow reversal in the abdominal aorta is a reliable indicator of a hemodynamically significant PDA, which correlates ... | 136 | ||
| Management of a Hemodynamically Significant PDA | 137 | ||
| Conservative Management: Strategies to Limit Shunt Volume | 137 | ||
| Ductal Closure Strategies | 137 | ||
| . Early postnatal ductal patency is promoted by circulating PGE2, whose production from membrane phospholipids is catalyzed by s... | 137 | ||
| . The administration of intravenous prophylactic indomethacin to extremely preterm infants after birth reduces the risk of intra... | 137 | ||
| . Early treatment of infants with echocardiographically diagnosed but clinically asymptomatic PDA prevents the administration of... | 137 | ||
| . Contemporary randomized controlled trials have compared the efficacy of early (day 3) vs late (after day 7 to 10) treatment of... | 138 | ||
| . Surgical PDA ligation is reserved as rescue therapy after failure or contraindication to pharmacologic treatment, often for in... | 138 | ||
| . Adrenocortical insufficiency is common in preterm infants undergoing PDA ligation, and infants should undergo a preoperative a... | 138 | ||
| HEART–LUNG INTERACTIONS IN THE INTENSIVE CARE UNIT: THE EFFECTS OF MECHANICAL VENTILATION ON HEMODYNAMICS | 138 | ||
| Atrial Preload | 138 | ||
| Initiation and Augmentation of Mechanical Ventilation, Premedication, and Intravascular Volume | 139 | ||
| Left Ventricular Function and Afterload: The Effects of Intrathoracic Pressure | 139 | ||
| Pulmonary Hypertension and Overcirculation: Lung Volumes and Pulmonary Vascular Resistance | 139 | ||
| REFERENCES | 139 | ||
| REFERENCES | 139.e1 | ||
| III - Oxygen Therapy, and Respiratory Support | 140 | ||
| 15 - Overview of Assisted Ventilation | 140 | ||
| UNIQUE CHALLENGES IN MECHANICAL VENTILATION OF NEWBORN INFANTS | 140 | ||
| Lung Mechanics | 140 | ||
| Uncuffed Endotracheal Tubes | 141 | ||
| Measurement of Tidal Volume | 141 | ||
| PRINCIPLES OF VENTILATOR DESIGN, FUNCTION, AND NOMENCLATURE | 141 | ||
| TEN MAXIMS FOR UNDERSTANDING MODES OF CONVENTIONAL VENTILATION | 142 | ||
| Defining a Ventilator Cycle | 142 | ||
| Defining the Assisted Breath | 142 | ||
| Assistance with Volume or Pressure Control | 142 | ||
| Trigger and Cycle Events | 142 | ||
| Machine versus Patient Trigger and Cycle Events | 143 | ||
| Spontaneous versus Mandatory “Breaths” | 143 | ||
| Breath/Inflation Sequences | 143 | ||
| Ventilatory Patterns | 144 | ||
| Targeting Schemes | 144 | ||
| Mode Classification | 145 | ||
| INITIATION OF MECHANICAL VENTILATION | 146 | ||
| Indications for Mechanical Ventilation | 146 | ||
| Choosing the Ventilator Mode | 146 | ||
| Initial Settings for Pressure-Controlled Ventilation | 149 | ||
| Assessment after Starting Ventilation | 149 | ||
| Subsequent Ventilator Adjustments | 151 | ||
| Oxygenation | 151 | ||
| Ventilation/CO2 Elimination | 151 | ||
| MONITORING AND DOCUMENTATION DURING MECHANICAL VENTILATION | 151 | ||
| VENTILATION PROTOCOLS | 152 | ||
| REFERENCES | 152 | ||
| REFERENCES | 152.e1 | ||
| 16 - Oxygen Therapy | 153 | ||
| HISTORY OF THE USE OF OXYGEN IN CLINICAL MEDICINE | 153 | ||
| BASIC PRINCIPLES OF OXYGEN PHYSIOLOGY | 153 | ||
| Aerobic Metabolism | 153 | ||
| Reactive Oxygen Species, Redox Regulation, and Antioxidant Enzymes | 154 | ||
| Redox Regulation | 154 | ||
| Antioxidant Defenses | 155 | ||
| Biomarkers of Oxidative Stress | 155 | ||
| Oxygen-Sensing Mechanisms and Physiologic Response | 156 | ||
| OXYGEN IN THE FETAL-TO-NEONATAL TRANSITION AND POSTNATAL ADAPTATION | 156 | ||
| Fetal-to-Neonatal Transition | 156 | ||
| Arterial Oxygen Saturation Nomogram | 157 | ||
| Oxygen Saturation in Preterm Infants with Positive Pressure Ventilation and Air | 158 | ||
| Oxygen Administration in the Delivery Room | 158 | ||
| Oxygen During Neonatal Care in the Neonatal Intensive Care Unit | 159 | ||
| Evolving Oxygen Needs in the First Weeks of Life and New Metabolic Indices | 160 | ||
| Going Home on Oxygen | 160 | ||
| Oxygen Saturation Recommendations | 161 | ||
| REFERENCES | 161 | ||
| REFERENCES | 161.e1 | ||
| 17 - Non-invasive Respiratory Support | 162 | ||
| BACKGROUND AND HISTORICAL ASPECTS | 162 | ||
| PHYSIOLOGIC EFFECTS OF CPAP | 164 | ||
| CLINICAL MANAGEMENT OF PATIENTS ON NASAL CPAP | 164 | ||
| METHODS OF GENERATING CONTINUOUS DISTENDING PRESSURE | 165 | ||
| NASAL AIRWAY INTERFACES | 167 | ||
| CLINICAL USE OF CPAP: RANDOMIZED, CONTROLLED TRIALS | 170 | ||
| Early CPAP with Rescue Surfactant | 170 | ||
| Conclusion | 172 | ||
| NONINVASIVE VENTILATION | 172 | ||
| Neurally Adjusted Ventilatory Assist | 173 | ||
| NASAL HIGH-FREQUENCY VENTILATION | 174 | ||
| Nasal CPAP or Noninvasive Ventilation for Apnea | 174 | ||
| COMPLICATIONS OF NONINVASIVE SUPPORT | 174 | ||
| Malpositioned Nasal Cannulae | 174 | ||
| Inadvertent Positive End-Expiratory Pressure | 174 | ||
| Carbon Dioxide Retention | 175 | ||
| Decreased Gastrointestinal Blood Flow | 175 | ||
| Skin Trauma | 175 | ||
| CONTRAINDICATIONS TO NASAL CPAP | 176 | ||
| DETERMINING OPTIMAL LEVELS OF NASAL CPAP | 176 | ||
| WEANING FROM CPAP | 176 | ||
| HUMIDIFIED HIGH-FLOW NASAL CANNULA | 177 | ||
| SUMMARY | 179 | ||
| REFERENCES | 179 | ||
| REFERENCES | 179.e1 | ||
| 18 - Basic Modes of Synchronized Ventilation | 180 | ||
| INTRODUCTION | 180 | ||
| TRIGGER TECHNOLOGY | 180 | ||
| BASIC SYNCHRONIZED MODES | 182 | ||
| Patient–Ventilator Interactions with Synchronized Ventilation | 182 | ||
| Synchronized Intermittent Mandatory Ventilation | 182 | ||
| Assist Control | 183 | ||
| Pressure-Support Ventilation | 184 | ||
| CHOICE OF ASSISTED VENTILATION MODES | 186 | ||
| GUIDELINES FOR CLINICAL APPLICATION | 186 | ||
| Synchronized Intermittent Mandatory Ventilation | 186 | ||
| Assist Control | 186 | ||
| Pressure-Support Ventilation | 187 | ||
| CONCLUSION | 187 | ||
| REFERENCES | 187 | ||
| REFERENCES | 187.e1 | ||
| 19 - Principles of Lung-Protective Ventilation | 188 | ||
| INTRODUCTION | 188 | ||
| NEONATAL RESPIRATORY FAILURE | 188 | ||
| VENTILATOR-INDUCED LUNG INJURY | 188 | ||
| Risk Factors for VILI | 188 | ||
| Volutrauma | 188 | ||
| Atelectrauma | 188 | ||
| Oxygen Toxicity | 189 | ||
| Pulmonary and Systemic Consequences of VILI | 189 | ||
| Structural Injury | 189 | ||
| Biotrauma | 189 | ||
| Surfactant Dysfunction | 189 | ||
| Lung Development | 190 | ||
| Susceptibility of Newborn Lungs to VILI | 190 | ||
| LUNG-PROTECTIVE VENTILATION: BASIC PRINCIPLES | 190 | ||
| Minimizing Volutrauma | 190 | ||
| Minimizing Atelectrauma | 190 | ||
| LUNG-PROTECTIVE VENTILATION: CONVENTIONAL MECHANICAL VENTILATION | 191 | ||
| Low Tidal Volume Ventilation | 191 | ||
| Tidal Volume Stabilization | 192 | ||
| Permissive Hypercarbia | 192 | ||
| Open Lung Ventilation | 192 | ||
| LUNG-PROTECTIVE VENTILATION: HIGH-FREQUENCY VENTILATION | 193 | ||
| LUNG-PROTECTIVE VENTILATION: WEANING AND EXTUBATION | 194 | ||
| IMPLICATIONS FOR PRACTICE AND RESEARCH | 194 | ||
| REFERENCES | 194 | ||
| REFERENCES | 194.e1 | ||
| 20 - Tidal Volume-Targeted Ventilation | 195 | ||
| RATIONALE FOR TIDAL VOLUME-TARGETED VENTILATION | 195 | ||
| VOLUME-CONTROLLED VERSUS VOLUME-TARGETED VENTILATION | 196 | ||
| NEONATAL TIDAL VOLUME-TARGETED VENTILATION | 197 | ||
| VOLUME GUARANTEE | 197 | ||
| SUGGESTED CLINICAL GUIDELINES (SEE ALSO TABLE 20-2) | 199 | ||
| PRESSURE-REGULATED VOLUME CONTROL | 201 | ||
| VOLUME VENTILATION PLUS | 201 | ||
| VOLUME-TARGETED VENTILATION | 202 | ||
| TARGETED TIDAL VOLUME | 202 | ||
| VOLUME LIMIT | 202 | ||
| IMPORTANCE OF OPEN LUNG STRATEGY | 202 | ||
| ALARMS/TROUBLESHOOTING | 202 | ||
| CONCLUSION | 202 | ||
| REFERENCES | 204 | ||
| REFERENCES | 204.e1 | ||
| 21 - Special Techniques of Respiratory Support | 205 | ||
| INTRODUCTION | 205 | ||
| CLOSED-LOOP CONTROL OF INSPIRED OXYGEN | 205 | ||
| VENTILATION TECHNIQUES | 206 | ||
| Proportional Assist Ventilation | 206 | ||
| NEURALLY ADJUSTED VENTILATORY ASSIST | 207 | ||
| Airway Pressure Release Ventilation | 208 | ||
| Targeted Minute Ventilation | 208 | ||
| Mandatory Minute Ventilation | 209 | ||
| Apnea Backup Ventilation | 209 | ||
| Adaptive Backup Ventilation | 209 | ||
| Adaptive Support Ventilation | 209 | ||
| Techniques to Reduce Dead Space | 210 | ||
| Continuous Tracheal Gas Insufflation | 210 | ||
| Washout of the Flow Sensor | 210 | ||
| Split-Flow Ventilation | 210 | ||
| SUMMARY | 210 | ||
| REFERENCES | 210 | ||
| REFERENCES | 210.e1 | ||
| 22 - High-Frequency Ventilation | 211 | ||
| TYPES OF HIGH-FREQUENCY VENTILATORS | 211 | ||
| Determinants of Gas Transport during Mechanical Ventilation | 211 | ||
| High-Frequency Jet Ventilators | 213 | ||
| High-Frequency Oscillators | 214 | ||
| High-Frequency Flow Interrupters | 214 | ||
| CLINICAL APPLICATIONS OF HIGH-FREQUENCY VENTILATION | 218 | ||
| Elective versus Rescue High-Frequency Ventilation | 218 | ||
| Lung Protective Strategies with HFV: Limiting Pressure While Optimizing Volume | 220 | ||
| APPLICATIONS OF HIGH-FREQUENCY VENTILATION IN SPECIFIC DISEASES | 221 | ||
| Respiratory Distress Syndrome | 221 | ||
| Air-Leak Syndromes | 221 | ||
| Pulmonary Hypoplasia, Persistent Pulmonary Hypertension, and Inhaled Nitric Oxide | 222 | ||
| CLINICAL GUIDELINES | 222 | ||
| Limiting Pressure Exposure | 223 | ||
| High-Frequency Jet Ventilators | 223 | ||
| High-Frequency Oscillatory Ventilators | 223 | ||
| Optimizing Lung Volume | 224 | ||
| High-Frequency Jet Ventilators | 224 | ||
| High-Frequency Oscillatory Ventilators | 225 | ||
| PROBLEMS, COMPLICATIONS, AND QUESTIONS WITHOUT ANSWERS | 226 | ||
| SUMMARY | 227 | ||
| REFERENCES | 228 | ||
| REFERENCES | 228.e1 | ||
| 23 - Mechanical Ventilation: Disease-Specific Strategies | 229 | ||
| RESPIRATORY DISTRESS SYNDROME | 229 | ||
| Key Pathophysiologic Features (Table 23-1) | 229 | ||
| Surfactant | 229 | ||
| Lung Liquid | 229 | ||
| Developmental Lung Biology | 229 | ||
| Relevant Principles of Ventilation | 230 | ||
| High-Frequency Ventilation | 231 | ||
| Conventional Ventilation | 231 | ||
| Extubation | 231 | ||
| Evidence-Based Recommendations | 233 | ||
| Gaps in Knowledge | 233 | ||
| MECONIUM ASPIRATION SYNDROME | 233 | ||
| Key Pathophysiologic Features | 233 | ||
| Surfactant Dysfunction | 233 | ||
| Airway Resistance | 234 | ||
| Pulmonary Hypertension | 234 | ||
| Relevant Principles of Ventilation | 234 | ||
| High-Frequency Ventilation | 234 | ||
| Conventional Ventilation | 235 | ||
| Evidence-Based Recommendations | 236 | ||
| Gaps in Knowledge | 236 | ||
| CONGENITAL DIAPHRAGMATIC HERNIA AND LUNG HYPOPLASIA DISORDERS | 236 | ||
| Key Pathophysiologic Features | 236 | ||
| Lung Hypoplasia | 236 | ||
| Pulmonary Vascular Bed | 237 | ||
| Cardiac Development | 237 | ||
| Relevant Principles of Ventilation | 237 | ||
| Pulmonary Hypertension | 238 | ||
| Evidence-Based Recommendations | 238 | ||
| Gaps in Knowledge | 238 | ||
| Key Pathophysiologic Features | 239 | ||
| Lung Pathology | 239 | ||
| Lung Mechanics and Function | 240 | ||
| Relevant General Principles of Mechanical Ventilation | 240 | ||
| Tracheostomy | 241 | ||
| Pulmonary Hypertension | 241 | ||
| Evidence-Based Recommendations | 242 | ||
| Gaps in Knowledge | 242 | ||
| SUMMARY | 242 | ||
| REFERENCES | 242 | ||
| REFERENCES | 242.e1 | ||
| 24 - Weaning from Mechanical Ventilation | 243 | ||
| BACKGROUND | 243 | ||
| WEANING FROM VENTILATORY SUPPORT | 243 | ||
| WEANING FROM PRESSURE-LIMITED VENTILATION | 244 | ||
| WEANING FROM HIGH-FREQUENCY VENTILATION | 244 | ||
| GENERAL STRATEGIES TO FACILITATE WEANING | 245 | ||
| Permissive Hypercarbia | 245 | ||
| Permissive Hypoxemia | 246 | ||
| WEANING PROTOCOLS | 246 | ||
| ADJUNCTIVE THERAPIES | 246 | ||
| Caffeine | 246 | ||
| Diuretics | 246 | ||
| Closure of Patent Ductus Arteriosus | 247 | ||
| Avoidance of Routine Sedation | 247 | ||
| Nutritional Support | 247 | ||
| Chest Physiotherapy | 247 | ||
| Systemic Corticosteroids | 247 | ||
| Inhaled Corticosteroids | 247 | ||
| ASSESSMENT OF EXTUBATION READINESS | 247 | ||
| Lung Mechanics and Minute Ventilation | 248 | ||
| Clinical Assessment: Spontaneous Breathing Trials | 248 | ||
| Analysis of the Dynamics of Physiologic Signals Prior to Extubation | 248 | ||
| POSTEXTUBATION MANAGEMENT | 249 | ||
| Adjunctive Therapies | 249 | ||
| Caffeine | 249 | ||
| Nebulized Racemic Epinephrine and Dexamethasone | 249 | ||
| Postnatal Corticosteroids for the Prevention and Treatment of Postextubation Stridor | 249 | ||
| Chest Physiotherapy | 249 | ||
| EXTUBATION FAILURE | 250 | ||
| SUMMARY | 250 | ||
| REFERENCES | 250 | ||
| REFERENCES | 250.e1 | ||
| 25 - Description of Available Devices | 251 | ||
| INTRODUCTION TO VENTILATORS | 251 | ||
| Power Inputs | 251 | ||
| Power Conversion and Control | 251 | ||
| Flow Control Valves | 251 | ||
| Power Outputs | 252 | ||
| Idealized Pressure, Volume, and Flow Waveforms | 253 | ||
| Ventilator Alarm Systems | 253 | ||
| Operator–Ventilator Interface: Displays | 253 | ||
| Alphanumeric Values | 253 | ||
| Trends | 254 | ||
| Waveforms and Loops | 254 | ||
| Patient–Ventilator Interface: Circuits | 254 | ||
| UNDERSTANDING MODES OF VENTILATION | 255 | ||
| Defining a Breath/Inflation | 255 | ||
| Assistance with Volume or Pressure Control | 255 | ||
| UNIVERSAL INTENSIVE CARE VENTILATORS USED FOR NEONATAL VENTILATION | 256 | ||
| CareFusion AVEA | 257 | ||
| Description | 257 | ||
| Operator Interface | 257 | ||
| Modes | 257 | ||
| . Airway pressure is maintained at a relatively high level for most of the respiratory cycle with intermittent release to a lowe... | 260 | ||
| . When Artificial Airway Compensation is turned on, the ventilator calculates the pressure at the airway opening required to del... | 260 | ||
| . All spontaneous breaths are pressure supported if the pressure support level is set above zero | 261 | ||
| . All spontaneous breaths are pressure supported: When a patient-triggered inflation exceeds the set volume limit, inflation is ... | 261 | ||
| . This is available for the neonatal patient size setting only. This mode is designed to work with standard two-limbed neonatal ... | 261 | ||
| . This mode is available for the neonatal patient size setting only. It is designed to work with standard two-limbed neonatal pa... | 261 | ||
| . All inspiratory efforts trigger a pressure-controlled inflation (provided the ventilator detects the effort). A preset frequen... | 261 | ||
| . Activation of flow cycle makes every inflation patient cycled. A backup rate will trigger the ventilator at the preset rate in... | 261 | ||
| . All inspiratory efforts trigger a pressure-controlled inflation. In this mode the ventilator switches from PC to VC if inflati... | 261 | ||
| . This mode is available for the neonatal patient size setting only | 261 | ||
| . Pressure-regulated volume control (PRVC) delivers pressure-controlled inflations that support every breath for which the press... | 261 | ||
| . This mode is as above, but flow cycled | 261 | ||
| . This mode is as above, but only a preset number of mandatory breaths is delivered in synchrony with inspiratory efforts (if pr... | 261 | ||
| . This mode is as above, but with time, not flow, cycling | 261 | ||
| . This mode is pressure-controlled SIMV | 261 | ||
| . The volume guarantee is the same as with A/C. Mandatory inflations are delivered at a preset rate and synchronized with inspir... | 261 | ||
| . Every inspiratory effort triggers a time-cycled pressure-limited inflation. Pressure-limited modes are flow controlled with a ... | 261 | ||
| . Every inspiratory effort triggers a flow-cycled pressure-limited inflation. This mode is equivalent to pressure support on oth... | 261 | ||
| IV - Initial Stabilization, Bedside Care, and Pharmacologic Adjuncts\r | 275 | ||
| 26 - Delivery Room Stabilization, and Respiratory Support | 275 | ||
| INTRODUCTION | 275 | ||
| PHYSIOLOGY OF TRANSITION, ASPHYXIA, AND RESUSCITATION | 275 | ||
| Physiology of Normal Transition | 275 | ||
| Physiology of Asphyxia | 275 | ||
| Physiology of Resuscitation | 276 | ||
| ANTICIPATION AND PREPARATION FOR RESUSCITATION | 276 | ||
| Training | 276 | ||
| Teamwork | 276 | ||
| Anticipation | 277 | ||
| Preparation | 277 | ||
| CLINICAL ASSESSMENT, APGAR SCORE, SATURATION, AND HEART RATE MONITORING | 278 | ||
| Clinical Evaluation | 278 | ||
| Pulse Oximetry and Electrocardiography | 278 | ||
| INTERVENTION BASICS: WARMTH, POSITION, SUCTION, STIMULATION | 278 | ||
| Warmth | 278 | ||
| Position | 279 | ||
| Suction | 279 | ||
| Meconium-Stained Amniotic Fluid | 279 | ||
| Stimulation | 279 | ||
| OXYGEN | 279 | ||
| VENTILATION | 279 | ||
| PRESSURE SOURCES | 280 | ||
| INTERFACES | 281 | ||
| ENDOTRACHEAL INTUBATION | 282 | ||
| INTUBATION EQUIPMENT AND PROCEDURE | 282 | ||
| LARYNGEAL MASK AIRWAY | 283 | ||
| MONITORING | 284 | ||
| CHEST COMPRESSIONS | 284 | ||
| EPINEPHRINE | 287 | ||
| VOLUME EXPANSION | 288 | ||
| SPECIAL CASES | 288 | ||
| Preterm Neonates | 288 | ||
| Congenital Diaphragmatic Hernia | 288 | ||
| Fetal Hydrops | 288 | ||
| ETHICS | 289 | ||
| Deciding Whether to Commence Resuscitation | 289 | ||
| Deciding Whether to Stop Resuscitation | 289 | ||
| POSTRESUSCITATION CARE | 290 | ||
| Examination/Monitoring | 290 | ||
| Therapeutic Hypothermia for Hypoxic–Ischemic Encephalopathy | 290 | ||
| REFERENCES | 290 | ||
| REFERENCES | 290.e1 | ||
| 27 - Respiratory Care of the Newborn | 291 | ||
| TECHNIQUES TO PROVIDE POSITIVE-PRESSURE VENTILATION | 291 | ||
| Manual Ventilation | 291 | ||
| Face Masks for Ventilation | 292 | ||
| Endotracheal Intubation | 292 | ||
| Routes of Intubation | 293 | ||
| Equipment | 294 | ||
| Types of Tubes | 294 | ||
| Depth of Tube Insertion | 295 | ||
| Determination of Placement | 295 | ||
| Tube Fixation | 295 | ||
| Acquisition and Maintenance of Intubation Skills | 296 | ||
| Laryngeal Mask Airway | 298 | ||
| NONINVASIVE VENTILATION AND CONTINUOUS POSITIVE AIRWAY PRESSURE | 298 | ||
| HEATED HUMIDIFIED HIGH-FLOW NASAL CANNULA | 298 | ||
| MONITORING DURING RESPIRATORY SUPPORT | 298 | ||
| Monitoring during Noninvasive Respiratory Support | 298 | ||
| Monitoring during Conventional and High-Frequency Ventilation | 299 | ||
| HUMIDIFICATION AND WARMING DURING RESPIRATORY SUPPORT | 300 | ||
| AIRWAY CLEARANCE TECHNIQUES | 301 | ||
| Chest Physiotherapy | 303 | ||
| Positioning of the Patient | 304 | ||
| Percussion and Vibration | 304 | ||
| ADMINISTRATION OF MEDICATIONS INTO THE RESPIRATORY TRACT | 306 | ||
| Surfactant Treatment | 306 | ||
| Surfactant Administration | 306 | ||
| Optimization of Aerosol Drug Delivery | 307 | ||
| CLINICIAN-BASED VENTILATOR AND WEANING PROTOCOLS | 308 | ||
| RESUSCITATION AND STABILIZATION AT DELIVERY | 309 | ||
| REFERENCES | 309 | ||
| REFERENCES | 309.e1 | ||
| 28 - Nursing Care\r | 310 | ||
| ASSESSMENT OF THE NEONATE | 310 | ||
| PAIN ASSESSMENT | 311 | ||
| RESPIRATORY CARE | 311 | ||
| Oxygen Saturation Monitoring | 312 | ||
| Positioning and Containment | 312 | ||
| Nasal Continuous Positive Airway Pressure | 313 | ||
| Mechanical Ventilation | 313 | ||
| Airway Security | 314 | ||
| Endotracheal Tube Movement and Malposition | 314 | ||
| Suctioning | 314 | ||
| Ventilator-Associated Pneumonia | 316 | ||
| High-Frequency Ventilation | 316 | ||
| Inhaled Nitric Oxide | 317 | ||
| Sudden Deterioration | 317 | ||
| GENERAL CARE OF THE NEONATE | 317 | ||
| Thermal Instability | 317 | ||
| Nutrition | 318 | ||
| Skin Care | 318 | ||
| Adhesive Application and Removal | 318 | ||
| Pressure Ulcers and Skin Breakdown | 319 | ||
| Managing Pain | 319 | ||
| Developmental Care | 320 | ||
| Skin-to-Skin Holding | 320 | ||
| CARE OF THE FAMILY | 320 | ||
| SUMMARY | 321 | ||
| REFERENCES | 321 | ||
| REFERENCES | 321.e1 | ||
| 29 - Nutritional Support | 322 | ||
| NUTRITIONAL REQUIREMENTS | 322 | ||
| Water Requirement | 322 | ||
| Insensible Water Loss | 322 | ||
| Renal Water Excretion | 322 | ||
| Energy Requirement | 323 | ||
| Protein Requirement | 323 | ||
| Lipid Requirement | 324 | ||
| Carbohydrate Requirement | 324 | ||
| Mineral Requirements | 325 | ||
| Vitamin Requirements | 326 | ||
| PARENTERAL NUTRITION | 326 | ||
| Intravenous Access | 327 | ||
| Composition of Total Parenteral Nutrition | 327 | ||
| ENTERAL NUTRITION | 327 | ||
| Advantages of Enteral Nutrition | 328 | ||
| Methods of Gavage Feeding | 328 | ||
| Minimal Enteral Feedings and Enteral Feeding Advancement | 328 | ||
| Composition of Enteral Nutrition | 328 | ||
| Human Milk | 328 | ||
| Donor Human Milk | 329 | ||
| Formulas | 329 | ||
| SPECIAL NUTRITIONAL CONSIDERATIONS FOR INFANTS WITH BRONCHOPULMONARY DYSPLASIA | 329 | ||
| REFERENCES | 329 | ||
| REFERENCES | 329.e1 | ||
| 30 - Complications of Respiratory Support | 330 | ||
| INTRODUCTION | 330 | ||
| EPIDEMIOLOGY | 330 | ||
| PATHOGENESIS | 331 | ||
| MICROBIOLOGY | 334 | ||
| DIAGNOSIS | 334 | ||
| PREVENTION | 335 | ||
| TREATMENT | 336 | ||
| CONCLUSION | 337 | ||
| REFERENCES | 337 | ||
| REFERENCES | 337.e1 | ||
| 31 - Pharmacologic Therapies I: Surfactant Therapy | 338 | ||
| HISTORY | 338 | ||
| SURFACTANT FUNCTION, COMPOSITION, AND METABOLISM | 338 | ||
| Function | 338 | ||
| Composition | 338 | ||
| Secretion and Metabolism | 338 | ||
| TYPES OF SURFACTANT | 339 | ||
| Animal-Derived Surfactants | 339 | ||
| Synthetic Surfactants without Protein Components | 339 | ||
| Protein-Containing Synthetic Surfactants | 340 | ||
| ACUTE PULMONARY AND CARDIAC EFFECTS OF SURFACTANT THERAPY | 340 | ||
| Immediate Pulmonary Effects of Surfactant Therapy | 340 | ||
| Immediate Effects on Pulmonary Circulation | 340 | ||
| Radiographic Changes | 340 | ||
| CLINICAL TRIALS OF SURFACTANT THERAPY | 340 | ||
| Surfactant Therapy Compared to Placebo or No Therapy | 340 | ||
| Prophylactic Surfactant Administration Compared to Postbirth Stabilization on Continuous Positive Airway Pressure and Selective ... | 341 | ||
| Early Surfactant Administration Followed Immediately by Extubation to Nasal Continuous Positive Airway Pressure | 342 | ||
| Targeted Surfactant Therapy | 343 | ||
| Single versus Multiple Surfactant Doses | 343 | ||
| Criteria for Repeat Doses of Surfactant | 343 | ||
| METHODS OF ADMINISTRATION OF SURFACTANT | 343 | ||
| Administration through Catheter, Side Port, or Suction Valve | 343 | ||
| Administration through Dual-Lumen Endotracheal Tube | 344 | ||
| Administration through a Laryngeal Mask Airway | 344 | ||
| Nasopharyngeal Administration of Surfactant | 344 | ||
| Thin Catheter Endotracheal Administration (Less-Invasive Surfactant Administration) | 344 | ||
| Other Methods | 344 | ||
| Chest Position during Administration of Surfactant | 345 | ||
| Summary of Administration Methods | 345 | ||
| CHOICE OF SURFACTANT PRODUCT | 345 | ||
| Comparison of Animal-Derived Surfactant Extract versus Protein-Free Synthetic Surfactant for the Prevention and Treatment of Res... | 345 | ||
| Comparison of Different Types of Bovine Surfactants | 346 | ||
| Comparison of Porcine and Bovine Surfactants | 346 | ||
| ADVERSE EFFECTS OF SURFACTANT THERAPY | 346 | ||
| ECONOMIC ASPECTS OF SURFACTANT THERAPY | 346 | ||
| FACTORS AFFECTING THE RESPONSE TO SURFACTANT THERAPY | 347 | ||
| LONG-TERM OUTCOMES AFTER SURFACTANT THERAPY | 347 | ||
| Neurodevelopmental Outcomes | 347 | ||
| Long-Term Respiratory Outcomes | 347 | ||
| Physical Growth | 347 | ||
| Outcomes of Prophylactic versus Rescue Treatment Strategies | 347 | ||
| EXOGENOUS SURFACTANT THERAPY FOR CONDITIONS OTHER THAN RESPIRATORY DISTRESS SYNDROME | 348 | ||
| Meconium Aspiration Syndrome | 348 | ||
| Acute Respiratory Distress Syndrome | 348 | ||
| Other Conditions | 348 | ||
| CONCLUSION | 348 | ||
| REFERENCES | 348 | ||
| REFERENCES | 348.e1 | ||
| 32 - Pharmacologic Therapies II: Inhaled Nitric Oxide | 349 | ||
| BACKGROUND | 349 | ||
| PHYSIOLOGY OF NITRIC OXIDE IN THE PULMONARY CIRCULATION | 351 | ||
| INITIAL EVALUATION OF THE TERM NEWBORN FOR INHALED NITRIC OXIDE THERAPY | 351 | ||
| History | 353 | ||
| Physical Examination | 353 | ||
| Interpretation of Pulse Oximetry Measurements | 354 | ||
| Laboratory and Radiologic Evaluation | 354 | ||
| Response to Supplemental Oxygen | 354 | ||
| Echocardiography | 354 | ||
| WHOM TO TREAT | 355 | ||
| Diseases | 355 | ||
| Clinical Criteria | 356 | ||
| Gestational and Postnatal Age | 356 | ||
| Severity of Illness | 356 | ||
| Treatment Strategies | 357 | ||
| Delivery of Nitric Oxide during Mechanical Ventilation | 357 | ||
| Dose | 357 | ||
| Duration of Treatment | 357 | ||
| Weaning | 357 | ||
| Discontinuation of Inhaled Nitric Oxide Therapy | 357 | ||
| Monitoring | 358 | ||
| Ventilator Management | 358 | ||
| ROLE OF INHALED NITRIC OXIDE IN NEWBORNS WITH CONGENITAL DIAPHRAGMATIC HERNIA | 359 | ||
| THE PREMATURE NEWBORN | 359 | ||
| SUMMARY | 361 | ||
| REFERENCES | 361 | ||
| REFERENCES | 361.e1 | ||
| 33 - Pharmacologic Therapies III: Cardiovascular Therapy and Persistent Pulmonary Hypertension of the Newborn | 362 | ||
| INTRODUCTION | 362 | ||
| NORMAL TRANSITION | 362 | ||
| HEMODYNAMIC PROBLEMS IN THE NEONATE | 363 | ||
| Persistent Pulmonary Hypertension of the Newborn | 363 | ||
| Clinical Evaluation | 363 | ||
| Intervention | 363 | ||
| Specific Therapy | 363 | ||
| Cardiovascular Support | 363 | ||
| Research Needs | 363 | ||
| Septic Shock | 363 | ||
| Clinical Evaluation | 364 | ||
| Research Needs | 364 | ||
| Hypoxic–Ischemic Encephalopathy | 364 | ||
| Cardiogenic Shock | 364 | ||
| Hypotension in the Extremely Low Gestational Age Newborn | 365 | ||
| CONCLUSION | 365 | ||
| REFERENCES | 365 | ||
| REFERENCES | 365.e1 | ||
| 34 - Pharmacologic Therapies IV: Other Medications | 366 | ||
| INTRODUCTION | 366 | ||
| STEROIDS | 366 | ||
| Early Postnatal (<8Days) Steroid Therapy for Prevention of Bronchopulmonary Dysplasia | 366 | ||
| Late (≥8Days) Postnatal Steroid Therapy for Prevention or Therapy of Bronchopulmonary Dysplasia in Preterm Infants | 367 | ||
| SEDATION AND ANALGESIA | 367 | ||
| Opioids | 368 | ||
| Morphine | 369 | ||
| Fentanyl | 370 | ||
| Dexmedetomidine | 370 | ||
| Benzodiazepines | 371 | ||
| Midazolam | 371 | ||
| Lorazepam | 372 | ||
| Diazepam | 372 | ||
| Other Sedative Agents | 372 | ||
| MUSCLE RELAXANTS | 372 | ||
| Pancuronium | 373 | ||
| Vecuronium | 373 | ||
| Rocuronium | 374 | ||
| Cisatracurium | 374 | ||
| BRONCHODILATORS AND MUCOLYTIC AGENTS | 374 | ||
| Albuterol (Salbutamol) | 374 | ||
| Cromoglycic Acid | 375 | ||
| Ipratropium Bromide | 375 | ||
| Racemic Epinephrine | 375 | ||
| N-Acetylcysteine | 375 | ||
| Combination Therapies | 376 | ||
| DIURETICS | 376 | ||
| Furosemide | 376 | ||
| Bumetanide | 377 | ||
| Thiazides and Potassium-Sparing Diuretics | 377 | ||
| RESPIRATORY STIMULANTS | 377 | ||
| Theophylline | 378 | ||
| Caffeine | 378 | ||
| Doxapram | 378 | ||
| SUMMARY | 379 | ||
| REFERENCES | 379 | ||
| REFERENCES | 379.e1 | ||
| V - Respiratory and Neurologic Outcomes, Surgical Interventions, and Other Considerations | 380 | ||
| 35 - Management of the Infant with Bronchopulmonary Dysplasia | 380 | ||
| INTRODUCTION | 380 | ||
| EPIDEMIOLOGY, PATHOPHYSIOLOGY AND DIAGNOSIS OF BRONCHOPULMONARY DYSPLASIA | 380 | ||
| CLINICAL PRESENTATION OF ESTABLISHED BRONCHOPULMONARY DYSPLASIA | 381 | ||
| Severe Lung Parenchyma Disease as the Leading Feature of Severe Bronchopulmonary Dysplasia | 382 | ||
| Pulmonary Hypertension as the Leading Feature of Severe Bronchopulmonary Dysplasia | 382 | ||
| Airway Disease as the Leading Feature of Severe Bronchopulmonary Dysplasia | 383 | ||
| PHYSIOLOGIC BASIS FOR RESPIRTORY SUPPORT IN INFANTS WITH ESTABLISHED BRONCHOPULMONARY DYSPLASIA | 383 | ||
| Ventilatory Control in Infants with Bronchopulmonary Dysplasia | 383 | ||
| Pulmonary Mechanics in Infants with Bronchopulmonary Dysplasia | 383 | ||
| RESPIRATORY MANAGEMENT IN INFANTS WITH ESTABLISHED BRONCHOPULMONARY DYSPLASIA | 383 | ||
| Noninvasive ventilation | 383 | ||
| Mechanical Ventilation | 384 | ||
| Conventional Mechanical Ventilation | 384 | ||
| . Because volutrauma has been associated with the development of lung injury, volume-targeted ventilation has been advocated in ... | 385 | ||
| . The majority of patients with sBPD have heterogeneous lung disease (see Fig. 35-3, B), with both collapsed and overinflated ar... | 385 | ||
| . Setting an appropriate PEEP is an important component of ventilator management. An appropriate level of PEEP can increase FRC,... | 386 | ||
| . High-frequency ventilation (HFV) delivers very small VTs with rapid rates. This may avoid large volume changes associated with... | 387 | ||
| ADJUNCT THERAPIES FOR THE RESPIRATORY SUPPORT OF INFANTS WITH ESTABLISHED BRONCHOPULMONARY DYSPLASIA | 387 | ||
| Heliox | 387 | ||
| Pharmacotherapy | 387 | ||
| Management of Pulmonary Hypertension | 388 | ||
| Management of Patent Ductus Arteriosus | 389 | ||
| Nutritional Support | 389 | ||
| Minimizing Pulmonary Microaspiration | 389 | ||
| Role of Tracheostomy in Infants Requiring Long-Term Support | 390 | ||
| PULMONRY OUTCOMES IN INFANTS WITH BRONCHOPULMONARY DYSPLASIA | 390 | ||
| CONCLUSIONS | 390 | ||
| REFERENCES | 390 | ||
| REFERENCES | 390.e1 | ||
| 36 - Medical and Surgical Interventions for Respiratory Distress and Airway Management | 391 | ||
| INTRODUCTION | 391 | ||
| MEDICAL MANAGEMENT OF THE NEONATAL AIRWAY | 391 | ||
| ANATOMIC DISADVANTAGES OF THE NEONATAL AIRWAY | 391 | ||
| MEDICAL MANAGEMENT OF NEONATES WITH COMMON RESPIRATORY DISORDERS REQUIRING SURGICAL INTERVENTION | 392 | ||
| Congenital Airway Disorders | 392 | ||
| Acquired Airway Disorders | 392 | ||
| SURGICAL MANAGEMENT OF THE NEONATAL AIRWAY | 393 | ||
| THE PEDIATRIC SURGEON/OTOLARYNGOLOGIST AS DIAGNOSTICIAN AND THERAPIST | 393 | ||
| Developmental Abnormalities of the Airway | 393 | ||
| Tracheal Obstruction | 393 | ||
| . The presence of stridor signals a need for urgent diagnosis and possible intervention due to the narrow size of the infant air... | 393 | ||
| . Choanal atresia, a rare anomaly, with a reported incidence of 1 in 8000 births, involves occlusion of the posterior nares by a... | 394 | ||
| Oropharyngeal Obstruction | 394 | ||
| . The tongue is often a site of obstruction. Stridor in a neonate can occur if the tongue is disproportionately larger than the ... | 394 | ||
| . Severe hypoglycemia, in many cases secondary to hyperinsulinemia, initially brought these examples of infantile gigantism to m... | 394 | ||
| . Several neonatal metabolic disorders cause macroglossia and result in congenital stridor, the best known of which are hypothyr... | 394 | ||
| . Children affected by Down syndrome are easily identified by their constellation of abnormalities. Their relative macroglossia ... | 395 | ||
| . Lingual thyroid can be a rare cause of oropharyngeal obstruction.22–24 Stertor in the presence of hypothyroidism, detected by ... | 395 | ||
| . Although not generally reported and not often appreciated, macroglossia can develop in infants with severe bronchopulmonary dy... | 395 | ||
| . The craniofacial dysmorphology syndromes range from unusual to extremely rare. All result in an obstruction located in the oro... | 395 | ||
| . Pierre Robin syndrome26-31 represents the most common craniofacial dysmorphology with micrognathia and glossoptosis. In additi... | 395 | ||
| . Treacher Collins syndrome,32 also known as mandibulofacial dysostosis, is a variable and diffuse group of craniofacial anomali... | 395 | ||
| . The Hallermann-Streiff syndrome33,34 is a rare syndrome that consists of microphth | 395 | ||
| . Infants with the Möbius syndrome35,36 have a characteristic absence or maldevelopment of various cranial nerve nuclei. Cranial... | 395 | ||
| . Infants with Freeman-Sheldon syndrome37,38 are often called “whistling-faced” children. They have hypoplastic alae nasi, clubb... | 395 | ||
| . Nager syndrome39–44 is a rare acrofacial dysostosis that presents with upper limb malformation, mandibular and malar hypoplasi... | 396 | ||
| . An infant’s larynx is the next site of possible obstruction, and laryngeal anomalies account for the majority of cases of stri... | 397 | ||
| . The most extreme form of obstruction at this level, laryngeal atresia, results in a desperate emergency during the first few m... | 397 | ||
| . Laryngeal webs account for approximately 5% of laryngeal anomalies (Fig. 36-5). These lesions arise about the 10th week of int... | 397 | ||
| . Congenital vocal cord paralysis is the second most common cause of congenital stridor. In the past, birth trauma was frequentl... | 397 | ||
| . Laryngomalacia is the most common cause of congenital stridor, accounting for 60% to 75% of cases of stridor in newborns. It a... | 397 | ||
| . The overall incidence of congenital subglottic stenosis is unknown because many such cases remain undiagnosed. It has been est... | 398 | ||
| . Acquired subglottic stenosis is most often caused by prolonged endotracheal intubation. Because of the increased survival of n... | 398 | ||
| . Although laryngeal clefts were once considered extremely rare lesions, they have frequently been reported since 1990.55 This i... | 398 | ||
| . Hemangiomas are another cause of congenital subglottic obstruction. The onset of symptoms is variable, as symptomatology is re... | 398 | ||
| Tracheal Anomalies | 399 | ||
| . Tracheal stenosis can involve either a short stenotic segment in an otherwise normal trachea or the entire trachea with a cyli... | 399 | ||
| . The necrotizing tracheobronchitis lesion is mainly of historical interest after having been reported in two relatively large s... | 399 | ||
| Extrinsic Tracheal Compression | 400 | ||
| . Vascular rings arise from anomalous form | 400 | ||
| Developmental Abnormalities of the Lung | 400 | ||
| Pulmonary and Lobar Agenesis | 400 | ||
| Pulmonary Hypoplasia | 400 | ||
| Congenital Lobar Emphysema | 401 | ||
| Congenital Cystic Adenomatoid Malformation | 401 | ||
| Sequestration | 401 | ||
| Pulmonary Cystic Lesions | 402 | ||
| Developmental Abnormalities of the Diaphragm | 402 | ||
| Diaphragmatic Hernia of Bochdalek | 402 | ||
| Diaphragmatic Paralysis/Eventration | 402 | ||
| Developmental Abnormalities of the Skeleton | 402 | ||
| THE PEDIATRIC SURGEON/OTOLARYNGOLOGIST AS CONSULTANT | 403 | ||
| Neonatal Bronchoscopy | 403 | ||
| Anatomic Considerations | 403 | ||
| Pathophysiology | 403 | ||
| Evaluation of Intubation | 403 | ||
| Endoscopes | 403 | ||
| Tracheostomy | 403 | ||
| Procedure | 404 | ||
| Anterior Cricoid Split Procedure | 405 | ||
| Tracheostomy Tubes | 405 | ||
| REFERENCES | 406 | ||
| REFERENCES | 406.e1 | ||
| 37 - Intraoperative Management of the Neonate | 407 | ||
| TRANSITIONAL PHYSIOLOGY AND PULMONARY HYPERTENSION | 407 | ||
| Key Points | 408 | ||
| PULMONARY DEVELOPMENT AND LUNG INJURY | 408 | ||
| Key Points | 409 | ||
| ANATOMIC CONSIDERATIONS | 409 | ||
| Intrathoracic Masses | 409 | ||
| Abdominal Wall Defects | 410 | ||
| Key Points | 410 | ||
| LOCATION OF OPERATION | 410 | ||
| Premedication for Intubation | 410 | ||
| Selection and Placement of the Endotracheal Tube | 411 | ||
| Key Points | 411 | ||
| OPERATIVE MANAGEMENT | 412 | ||
| Ventilator Mode | 412 | ||
| Vital Signs | 413 | ||
| Intraoperative Fluid Management and Electrolyte Management | 413 | ||
| Key Points | 414 | ||
| TROUBLESHOOTING | 414 | ||
| ADDITIONAL OPERATIVE CONSIDERATIONS | 414 | ||
| Temperature Regulation | 414 | ||
| Neonate Pain Perception | 415 | ||
| CONCLUSION | 415 | ||
| REFERENCES | 415 | ||
| REFERENCES | 415.e1 | ||
| 38 - Neonatal Respiratory Care in Resource-Limited Countries | 416 | ||
| SCOPE OF THE NEED | 416 | ||
| LIMITING FACTORS | 416 | ||
| Respiratory Care Program Barrier | 417 | ||
| Infrastructure | 417 | ||
| Skilled Health Care Personnel | 417 | ||
| Support Equipment | 417 | ||
| CURRENT STATUS | 417 | ||
| China | 417 | ||
| India | 418 | ||
| Other Countries | 418 | ||
| ESTABLISHING RESPIRATORY CARE PROGRAMS | 419 | ||
| Leadership and Partnership | 419 | ||
| Implementation | 419 | ||
| Infrastructure | 420 | ||
| Resources | 420 | ||
| Equipment for Respiratory Care Programs | 421 | ||
| Ventilators | 421 | ||
| Clinical Care Pathways | 421 | ||
| Clinical Monitoring | 422 | ||
| Education | 422 | ||
| Evaluation | 422 | ||
| PROJECTED GROWTH IN NEONATAL VENTILATION—A GLOBAL PERSPECTIVE | 422 | ||
| OUTCOMES OF NEONATAL VENTILATION | 423 | ||
| ETHICAL DILEMMAS | 423 | ||
| CONCLUSIONS | 423 | ||
| REFERENCES | 424 | ||
| REFERENCES | 424.e1 | ||
| 39 - Transport of the Ventilated Infant | 425 | ||
| IMPORTANT ROLE OF THE TRANSPORT TEAM | 425 | ||
| REGIONALIZED CARE | 425 | ||
| TRANSPORT TEAM COMPOSITION | 426 | ||
| TRANSPORT EDUCATION | 427 | ||
| TRANSPORT PHYSIOLOGY | 427 | ||
| Hypoxia | 427 | ||
| Air Expansion | 427 | ||
| Noise and Vibration | 427 | ||
| Thermoregulation | 428 | ||
| STABILIZATION | 428 | ||
| CLINICAL ISSUES | 428 | ||
| EQUIPMENT | 429 | ||
| Transport Ventilators | 430 | ||
| High-Frequency Ventilation | 431 | ||
| Continuous Positive Airway Pressure | 432 | ||
| Surfactant Administration | 432 | ||
| Inhaled Nitric Oxide | 432 | ||
| Extracorporeal Membrane Oxygenation | 433 | ||
| Hypothermia for Hypoxic Ischemic Encephalopathy | 433 | ||
| FUTURE DIRECTIONS | 433 | ||
| REFERENCES | 433 | ||
| REFERENCES | 433.e1 | ||
| 40 - Extracorporeal Membrane Oxygenation | 434 | ||
| HISTORY OF CARDIOPULMONARY BYPASS | 434 | ||
| Development of Membrane Oxygenators | 434 | ||
| Development of a Pump | 435 | ||
| Vascular Access | 435 | ||
| PHYSIOLOGY OF EXTRACORPOREAL CIRCULATION | 435 | ||
| Membrane Lung | 435 | ||
| Oxygen and Carbon Dioxide Transfer | 435 | ||
| PATIENT SELECTION | 437 | ||
| Disease States | 437 | ||
| Selection Criteria | 437 | ||
| Alveolar–Arterial Oxygen Gradient | 437 | ||
| Oxygenation Index | 438 | ||
| Acute Deterioration | 438 | ||
| Barotrauma | 439 | ||
| Contraindications | 439 | ||
| Evaluation before Extracorporeal Membrane Oxygenation | 439 | ||
| TECHNIQUE FOR BEGINNING ECMO | 439 | ||
| Before Cannulation | 439 | ||
| Venoarterial versus Venovenous Cannulation | 440 | ||
| Operative Procedure | 440 | ||
| DAILY MANAGEMENT | 441 | ||
| WEANING | 443 | ||
| Carotid Artery Repair | 443 | ||
| OUTCOME | 443 | ||
| REFERENCES | 445 | ||
| REFERENCES | 445.e1 | ||
| 41 - Discharge and Transition to Home Care | 446 | ||
| FACTORS TO CONSIDER WHEN DETERMINING READINESS FOR DISCHARGE | 446 | ||
| DISCHARGE TEAM | 447 | ||
| PREDISCHARGE NEEDS ASSESSMENT | 447 | ||
| HOME ENVIRONMENT | 447 | ||
| EQUIPMENT AND SUPPLIES | 447 | ||
| PERSONNEL RESOURCES | 447 | ||
| HOME NURSING | 448 | ||
| EMERGENCY PLANNING | 448 | ||
| POSTDISCHARGE FOLLOW-UP | 448 | ||
| TRACHEOSTOMY CARE | 448 | ||
| CHANGING TRACHEOSTOMY TUBES | 448 | ||
| OUTPATIENT MANAGEMENT OF SUPPLEMENTAL OXYGEN THERAPY | 449 | ||
| INDICATIONS FOR HOME OXYGEN THERAPY | 449 | ||
| Hypoxemia | 449 | ||
| Growth Failure | 449 | ||
| Intermittent Hypoxia and Pulmonary Hypertension | 449 | ||
| OXYGEN DELIVERY SYSTEMS FOR HOME OXYGEN THERAPY | 449 | ||
| OXYGEN CONCENTRATOR | 449 | ||
| LIQUID OXYGEN | 449 | ||
| HIGH-PRESSURE SYSTEMS | 449 | ||
| Strategies for Discontinuation of Home Oxygen Therapy | 450 | ||
| REFERENCES | 450 | ||
| REFERENCES | 450.e1 | ||
| 42 - Neurologic Effects of Respiratory Support | 451 | ||
| CEREBRAL BLOOD FLOW IN THE NEONATE | 451 | ||
| Cerebral Autoregulation and Pressure-Passive Circulation | 451 | ||
| BRAIN INJURY IN THE PRETERM INFANT | 451 | ||
| Periventricular–Intraventricular Hemorrhage | 452 | ||
| Periventricular Hemorrhagic Infarction (Grade 4 Intraventricular Hemorrhage) | 453 | ||
| Periventricular Leukomalacia and Diffuse White Matter Injury | 453 | ||
| INFLUENCE OF OXYGEN CONCENTRATION AND CARBON DIOXIDE ON CEREBRAL BLOOD FLOW | 454 | ||
| Oxygen and Hemoglobin | 454 | ||
| Carbon Dioxide | 454 | ||
| Hypocarbia and White Matter Injury | 455 | ||
| Hypercarbia and Intraventricular Hemorrhage | 455 | ||
| Oxygen and Brain Injury | 455 | ||
| MODE OF VENTILATION AND BRAIN INJURY | 456 | ||
| Continuous Positive Airway Pressure | 456 | ||
| Conventional Mechanical Ventilation | 456 | ||
| High-Frequency Oscillatory Ventilation | 456 | ||
| MEDICATIONS USED TO TREAT RESPIRATORY CONDITIONS | 456 | ||
| Surfactant | 456 | ||
| Methylxanthines | 456 | ||
| Inhaled Nitric Oxide | 457 | ||
| Postnatal Steroids | 457 | ||
| SUMMARY | 457 | ||
| REFERENCES | 458 | ||
| REFERENCES | 458.e1 | ||
| 43 - Pulmonary and Neurodevelopmental Outcomes Following Ventilation | 459 | ||
| INTRODUCTION | 459 | ||
| BRONCHOPULMONARY DYSPLASIA | 459 | ||
| Definitions of Bronchopulmonary Dysplasia | 459 | ||
| PULMONARY OUTCOMES | 460 | ||
| Pulmonary Function Testing and Imaging | 461 | ||
| Respiratory Illnesses/Wheezing or Asthma | 461 | ||
| HEALTH CARE UTILIZATION | 462 | ||
| NEURODEVELOPMENTAL OUTCOMES AND BRONCHOPULMONARY DYSPLASIA | 462 | ||
| OUTCOMES AFTER NEONATAL HYPOXIC RESPIRATORY FAILURE | 463 | ||
| Inhaled Nitric Oxide | 463 | ||
| Extracorporeal Membrane Oxygenation | 463 | ||
| CONCLUSION | 463 | ||
| REFERENCES | 464 | ||
| REFERENCES | 464.e1 | ||
| APPENDICES | 465 | ||
| APPENDIX 1 | 466 | ||
| APPENDIX 2 | 466 | ||
| APPENDIX 3 | 466 | ||
| APPENDIX 4 | 467 | ||
| Normal Lung Function Data for Term Newborns during the Neonatal Period | 467 | ||
| APPENDIX 5 | 467 | ||
| Allen’s Test | 467 | ||
| APPENDIX 6 | 467 | ||
| Procedure for Obtaining Capillary Blood Gases | 467 | ||
| APPENDIX 7 | 467 | ||
| Normal Umbilical Cord Blood Gas Values | 467 | ||
| APPENDIX 8 | 468 | ||
| APPENDIX 9 | 469 | ||
| Capillary Blood Gas Reference Values in Healthy Term Neonates | 469 | ||
| APPENDIX 10 | 469 | ||
| Blood Gas Values in Cord Blood and in Arterial Blood at Various Ages during the Neonatal Period | 469 | ||
| Oxygen Tension | 469 | ||
| Carbon Dioxide Tension | 469 | ||
| pH | 469 | ||
| Base Excess | 469 | ||
| APPENDIX 11 | 470 | ||
| Conversion Tables | 470 | ||
| Torr to Kilopascal | 470 | ||
| Kilopascal to Torr | 470 | ||
| APPENDIX 12 | 470 | ||
| Hemoglobin–Oxygen Dissociation Curves | 470 | ||
| APPENDIX 13 | 471 | ||
| Siggaard–Andersen Alignment Nomogram | 471 | ||
| APPENDIX 14 | 472 | ||
| Systolic, Diastolic, and Mean Blood Pressure by Birth Weight and Gestational Age | 472 | ||
| APPENDIX 15 | 473 | ||
| Systolic and Diastolic Blood Pressure in the First 5Days of Life | 473 | ||
| APPENDIX 16 | 474 | ||
| Neonatal Resuscitation Record | 474 | ||
| APPENDIX 17 | 475 | ||
| Effective FiO2 Conversion Tables for Infants on Nasal Cannula | 475 | ||
| APPENDIX 18 | 477 | ||
| Neonatal Indications and Doses for Administration of Selected Cardiorespiratory Drugs | 477 | ||
| Cardiorespiratory Pharmacopeia for the Newborn Period | 477 | ||
| Administration Routes | 477 | ||
| ALVEOLAR–ARTERIAL OXYGEN GRADIENT | 481 | ||
| Respiratory Quotient and Barometric Pressure | 481 | ||
| Information About Alveolar–Arterial Oxygen Gradient and PaO2/FiO2 Ratio | 481 | ||
| COMPLETE ABG | 482 | ||
| For Metabolic Alkalosis | 483 | ||
| ETCO2 TUTOR | 485 | ||
| INDEX | 487 | ||
| A | 487 | ||
| B | 488 | ||
| C | 488 | ||
| D | 490 | ||
| E | 490 | ||
| F | 491 | ||
| G | 491 | ||
| H | 491 | ||
| I | 492 | ||
| J | 493 | ||
| K | 493 | ||
| L | 493 | ||
| M | 493 | ||
| N | 494 | ||
| O | 495 | ||
| P | 495 | ||
| Q | 497 | ||
| R | 497 | ||
| S | 498 | ||
| T | 499 | ||
| U | 499 | ||
| V | 499 | ||
| W | 500 | ||
| X | 500 | ||
| IBC | ES2 |