medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2012, Number 5

Next >>

Rev Invest Clin 2012; 64 (5)

Mechanical ventilation parameters associated to barotrauma in a neonatal intensive care unit

Tapia-Rombo CA, Quezada-Cuevas SE, Uscanga-Carrasco H, Aguilar-Solano AMG, Castillo-Pérez JJ

Language: Spanish
References: 42
Page: 407-419
PDF size: 254.60 Kb.


ABSTRACT

Objective. To identify the parameters of mechanical ventilation related to barotrauma and to identify associated diseases. Material and methods. There was a partial retrospective study which included all the files and/or newborns (NB) who were in the Neonatal Intensive Care Unit during March 2003 to April 2008 met the inclusion criteria. Two groups were conformed, the group A, cases (those with barotrauma) and B controls (that did not show it). Area of significance was considered when p ‹ 0.05. Results. In multivariate analysis was only significant relevance in relation to the ventilatory parameters mean airway pressure (MAP) › 10 cm H2O on the eighth day, and as confronted all variables including one different from the ventilator as arterial blood gases in the multivariate analysis also, the oxygenation index (OI) with a value › 10 showed statistical significance as it preceded to the barotrauma. The pathology associated with barotrauma was patent ductus arteriosus (PDA) hemodynamically significant with p ‹ 0.05. Conclusions. Based on the foregoing its is concluded that when a NB patient with mechanical ventilatory support after the first days, to improve lung compliance should be going down different ventilatory parameters as soon as possible to avoid reaching a MAP › 10 cm H2O above the eighth day of ventilatory management, but OI › 10 at any time would be announcing the possibility of barotrauma and other side to treat the significant hemodynamically PDA either medically or surgically in the shortest time.


REFERENCES

  1. Greenough A, Donn SM. Matching ventilatory support strategies to respiratory pathophysiology. Clin Perinatol 2007; 34: 35-53, v-vi.

  2. Montgomery M. Air and liquid in the pleural space. In: Chernick V, Boat TF (eds.). Kendig’s disorders of the respiratory tract in children. 6th. ed. Filadelfia: W.B. Sounders Company; 1998, p. 389-411.

  3. Ngerncham S, Kittiratsatcha P, Pacharn P. Risk factors of pneumothorax during the first 24 hours of life. J Med Assoc Thai 2005; 88 (Sup. 8): S135-S141.

  4. Trevisanuto D, Doglioni N, Ferrarese P, Vedovato S, Cosmi F, Zanardo V. Neonatal pneumothorax: comparison between neonatal transfers and inborn infants. J Perinat Med 2005; 33: 449-54.

  5. Berk DR, Varich LJ. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation. Pediat Radiol 2005; 35: 1243-45.

  6. Rao J, Hochman MI, Miller GG. Localized persistent pulmonary interstitial emphysema. J Pediatr Surg 2006; 41: 1191-3.

  7. Halamek LP, Morley C. Continuous positive airway pressure during neonatal resuscitation. Clin Perinatol 2006; 33: 83-98, vii.

  8. Goldsmith JP, Karotkin EH. Ventilación asistida neonatal. 4a. ed. Bogotá: Editorial Distribuna; 2005, p. 44, 46, 187, 369, 537-9.

  9. Loring SH, Malhotra A. Inspiratory efforts during mechanical ventilation: is there risk of barotrauma? Chest 2007; 131: 646-8.

  10. Tapia-Rombo CA, Domínguez-Martínez R, Saucedo-Zavala V, Cuevas-Uriostegui M. Factores de riesgo para la presencia de complicaciones de la asistencia mecánica ventilatoria en el recién nacido. Rev Invest Clin 2004; 56: 700-11.

  11. Tapia-Rombo CA, Rodríguez-Jiménez G, Ballesteros-del-Olmo JC, Cuevas-Urióstegui ML. Factores asociados a complicaciones de la asistencia mecánica ventilatoria en el recién nacido prematuro. Gac Med Mex 2009; 145: 273-83.

  12. Singh J, Sinha SK, Donn SM. Volume-targeted ventilation of newborns. Clin Perinatol 2007; 34: 93-105, vii [Review].

  13. Greenough A, Dimitriou G, Prendergast M, Milner AD. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst Rev 2008. Enero 23: (1): CD000456 [Review].

  14. Singh J, Sinha SK, Clarke P, Byrne S, Donn SM. Mechanical ventilation of very low birth weight infants: Is volume or pressure a better target variable? J Pediatr 2006; 149: 308-13.

  15. Escobar GJ, Shaheen SM, Breed EM, et al. Richardson score predicts short-term adverse respiratory outcomes in newborn >/= 34 weeks gestation. J Pediatr 2004; 145: 754-60.

  16. Kamlin COF, Davis PG. Tiempos inspiratorios prolongados versus cortos en recién nacidos bajo ventilación mecánica. Bibl Cochrane Plus 2007; 2 Oxford. Disponible en http://www.op date-software.com

  17. Reynolds EOR. Effect of alterations in mechanical ventilator settings on pulmonary gas exchange in hyaline membrane disease. Arch Dis Child 1971; 46: 152-9.

  18. Knudesen NW, Fulkerson WS. Lesión pulmonar causada por ventilación mecánica. En: Maclntyre NR, Branson RD (eds.). Ventilación Mecánica. México, D.F.: Mac Graw Hill Interamericana Editores S.A. de C.V.; 2002, p. 223-33.

  19. Secretaría de Salud, Centro Nacional de Excelencia Tecnológica en Salud. Guía Tecnológica No. 5: ventilador neonatal (GMDN 14361). Cenetec, Salud. Agosto del 2004. México.

  20. Rocha G, Saldanha J, Macedo I, Areias A. Respiratory support strategies for the preterm newborn-National survey 2008. Rev Port Pneumol 2009; 15: 1043-71.

  21. Young MJ, Bresnitz EA, Strom BL. Sample size nomograms for interpreting negative clinical studies. Ann Intern Med 1983; 99: 248-51.

  22. Schulze A, Gerhardt T, Musante G, et al. Proportional assist ventilation in low birth weight infants with acute respiratory disease: A comparison to assist/control and conventional mechanical ventilation. J Pediatr 1999; 135: 339-44.

  23. Cnaan A, Laird NM, Slasor P. Using the general mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med 1997; 16: 2349-80.

  24. Naumova EN, Must A, Laird NM. Tutorial in biostatistics: Evaluating the impact of critical periods in longitudinal studies of growth using piecewise mixed effects models. Int J Epidemiol 2001; 30: 1332-41.

  25. Little Roderick J, Raghunathan trivellore. On summary measures analysis of the linear mixed effects model for repeated measures when data are not missing completely at random. Stat Med 1999; 18: 2465-78.

  26. Garrett Fitzmaurice, Nan Laird, James Ware. Applied Longitudinal Analysis. John Wiley & Sons; 2002.

  27. Khuri A, Mathew T, Sinha B. Statistical Test for Mixed Linear Models. John Wiley & Sons; 1998.

  28. Lipsitz SR, Fitzmaurice GM. Sample size for repeated measures studies with binary responses. Stat Med 1994; 13(12): 1233-9.

  29. Alfageme MI, Álvarez MA, Álvarez FJA, et al. Insuficiencia respiratoria en el recién nacido. Disponible en http:// tratado.unitet.edu/c120501.html

  30. Carlo WA, Martín RJ. Principios de la ventilación asistida neonatal. Clin Ped Norteam 1986; 231-48.

  31. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149: 818-24.

  32. Carlton DP, Cummings JJ, Scheerer RG, Poulain FR, Bland RD. Lung overexpansion increases pulmonary microvascular protein permeability in young lambs. J Appl Physiol 1990; 69: 577-83.

  33. Hernández LA, Peevy KJ, Moise AA, Parker JC. Chest wall restriction limits high airway pressure-induced lung injury in young rabbits. J Appl Physiol 1989; 66: 2364-68.

  34. Golombek SG, Sola A, Baquero H, et al. Primer consenso clínico de SIBEN: enfoque diagnóstico y terapéutico del ductus arterioso permeable en recién nacidos pretérmino. An Pediatr (Barc) 2008; 69: 454-81.

  35. Jasso L. Neonatología Práctica. 6a. Ed. México, D.F.: Manual Moderno, 2005, p. 218.

  36. Tapia-Rombo CA, Rosales-Cervantes MGI, Saucedo-Zavala VJ, Ballesteros-del-Olmo JC, Sánchez-García L, Santos-Vera I. Saturación periférica de oxígeno por oximetría de pulso en recién nacidos clínicamente sanos, a la altitud de la Ciudad de México (2,240 m). Gac Med Mex 2008; 144: 207-12.

  37. Kraybill EN, Runayan DK, Bose CL, Khan JH. Risk factors for chronic lung disease in infants with birth weight of 751 to 1000 grams. J Pediatr 1989; 115: 115-20.

  38. Yu VY, Wong PY, Bajuk B, Szymonowicz W. Pulmonary air leak in extremely low birthweight infants. Arch Dis Child 1986; 6: 239-41.

  39. Hansen T, Corbert A. Síndromes por bloqueo de aire. En: Taeusch HW, Ballard RA (eds.). Tratado de Neonatología de Avery. 7a. ed. Filadelfia: Harcourt; 2000, p. 630-33.

  40. López-Candiani C, Soto-Portas LC, Gutiérrez-Castrellón P, Rodríguez- Weber MA, Udaeta-Mora E. Complicaciones de la ventilación mecánica en neonatos. Acta Pediatr Mex 2007; 28: 63-8.

  41. Tapia-Rombo CA, Galindo-Alvarado AM, Saucedo-Zavala VJ, Cuevas-Urióstegui ML. Factores predictores de falla en la extubación en recién nacidos de pretérmino. Gac Med Mex 2007; 143: 101-08.

  42. Tapia-Rombo CA, Cortés-Ortiz RE, Uscanga-Carrasco H, Tena-Reyes D. Factores asociados para falla en la extubación de recién nacidos de término de una Unidad de Cuidados Intensivos Neonatales. Rev Invest Clin 2011; 63: 484-93.




2020     |     www.medigraphic.com