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Found 20 results

  1. Dear all As all of us are preparing ourselves to form potential strategies to mitigate and manage SARS CoV2 positive neonates, we come across various challenges. Our NICU has Sophie ventilators which do not have a expiratory filter. So the potentially infectious aerosols would be released in the NICU environment. We have not been able to devise a way to circumvent that yet. Though thankfully there have been no suspect cases so far in Delhi. But in order to prepare for a possible surge it is essential to look at such issues. Please suggest what is being followed in othe
  2. until
    After (another) successful meeting with NAVA enthusiast from several countries, we are ready to announce the date of the next workshop! The goal of this event is to increase skills on the use of NAVA ventilation in the NICUs, which already have some experience with NAVA and they have a Servo-i or Servo-n ventilator. Date: 05-06.09.2019 Location: Turku, Finland Registration fee: 600€ + taxes (incl. lunches and refreshments during the workshops) How to register: contact Hanna Soukka (hanna.soukka@utu.fi or NAVA@tyks.fi before June 30, 2019) The preliminary program
  3. InSurE (Intubate, Surfactant, Extubate) has been the standard approach for some time when it comes to treating RDS. Less Invasive Surfactant Administration (LISA) or Minimally Invasive Surfactant Administration (MIST) have been growing in popularity as an alternative technique. More than just popular, the techniques have been shown to reduce some important short term and possibly long term outcomes when used instead of the InSurE approach. Aldana-Aquirre et al published the most recent systematic review on the topic in Less invasive surfactant administration versus intubation for surfactan
  4. until
    The goal of this event is to increase skills on the use of NAVA ventilation in the NICUs, which already have some experience of NAVA and they have a Servo-i or Servo-n ventilator. Last 5 places available! Date: 24-25.01.2019 Location: Turku, Finland Registration fee: 600€ + taxes (incl. lunches and refreshments during the workshops) How to register: contact Hanna Soukka (hanna.soukka@utu.fi or NAVA@tyks.fi before November 30, 2018) Preliminary program is attached below. In case of any questions, don't hesitate to ask here or email! On behalf of Hanna
  5. Caffeine seems to be good for preterm infants. We know that it reduces the frequency of apnea in the this population and moreover facilitates weaning off the ventilator in a shorter time frame than if one never received it at all. The earlier you give it also seems to make a difference as shown in the Cochrane review on prophylactic caffeine. When given in such a fashion the chances of successful extubation increase. Less time on the ventilator not surprisingly leads to less chronic lung disease which is also a good thing. I have written about caffeine more than once though so why is
  6. The lungs of a preterm infant are so fragile that over time pressure limited time cycled ventilation has given way to volume guaranteed (VG) or at least measured breaths. It really hasn’t been that long that this has been in vogue. As a fellow I moved from one program that only used VG modes to another program where VG may as well have been a four letter word. With time and some good research it has become evident that minimizing excessive tidal volumes by controlling the volume provided with each breath is the way to go in the NICU and was the subject of a Cochrane review entitled Volume-t
  7. until
    https://www.mcascientificevents.eu/intensive-care-newborn2018/ MAIN TOPICS Resuscitation Oxygen And Ventilation Infections High-Tech Monitoring Nursing Ventilation
  8. This past week, Canada lost a rock icon in Gord Downie of the Tragically Hip. My late high school, university and medical school days seem to have him and the band forever enmeshed in memories from that time. In honour of his passing I thought it suitable to pay tribute to him by using one of the band’s famous song titles as the title for this post. No this isn’t a post about the band but rather a controversial ventilation strategy. While CPAP has been around for some time to support our infants after extubation, a new method using high frequency nasal ventilation has arrived and just does
  9. It has been over two years since I have written on this subject and it continues to be something that I get excited about whenever a publication comes my way on the topic. The last time I looked at this topic it was after the publication of a randomized trial comparing in which one arm was provided automated FiO2 adjustments while on ventilatory support and the other by manual change. Automated adjustments of FiO2. Ready for prime time? In this post I concluded that the technology was promising but like many new strategies needed to be proven in the real world. The study that the post was ba
  10. I know how to bag a baby. At least I think I do. Providing PPV with a bag-valve mask is something that you are taught in NRP and is likely one of the first skills you learned in the NICU. We are told to squeeze the bag at a rate of 40-60 breaths a minute. According to the Laerdal website, the volume of the preterm silicone bag that we typically use is 240 mL. Imagine then that you are wanting to ventilate a baby who is 1 kg. How much should you compress the bag if you wish to delivery 5 mL/kg. Five ml out of a 240 mL bag is not a lot of squeeze is it? Think about that the next time you
  11. Positive pressure ventilation puts infants at risk of developing chronic lung disease (CLD). Chronic lung disease in turn has been linked many times over, as a risk for long term impacts on development. So if one could reduce the amount of positive pressure breaths administered to a neonate over the course of their hospital stay, that should reduce the risk of CLD and by extension developmental impairment. At least that is the theory. Around the start of my career in Neonatology one publication that carried a lot of weight in academic circles was the Randomized Trial of Permissive Hypercapn
  12. As the saying goes the devil is in the details. For some years now many centres worldwide have been publishing trials pertaining to high flow nasal cannulae (HFNC) particularly as a weaning strategy for extubation. The appeal is no doubt partly in the simplicity of the system and the perception that it is less invasive than CPAP. Add to this that many centres have found less nasal breakdown with the implementation of HFNC as standard care and you can see where the popularity for this device has come from. This year a contact of mine Dominic Wilkinson@NeonatalEthics on twitter (if yo
  13. As I was preparing to settle in tonight I received a question from a reader on my Linkedin page in regards to the use of sustained inflation (SI) in our units. We don't use it and I think the reasons behind it might be of interest to others. The concept of SI is that by providing a high opening pressure of 20 - 30 cm H2O for anywhere from 5 to 15 seconds one may be able to open the "stiff" lung of a preterm infant with RDS and establish an adequate functional residual capacity. Once the lung is open, it may be possible in theory to keep it open with ongoing peep at a more traditional level
  14. Ask almost anyone who has worked in the field of Neonatology for some time and they will tell you that babies are not as sick as they once were. We can give a lot of credit to better antenatal steroid use, maternal nutrition and general management during pregnancy. Additionally, after birth we now rush to place infants on CPAP and achieve adequate expansion of the lungs which in many cases staves off intubation. The downside to our success though is that the opportunities to provide positive pressure ventilation (PPV) and moreover intubation are becoming less and less. How then do we pe
  15. I will admit it. I resist change at times just like many others. This may come as a surprise to some of you who have worked with me and accused me of bringing too much change at times to the units. The truth though is that when one understands something and is enthusiastic about implementation the change does not seem so difficult. When it isn't your idea though we may find ourselves a little uneasy about adopting this unfamiliar practice. Such has been my experience with nasal HFOV. It is a strategy that has been around for over five years but has seen slow adoption among centres in
  16. until
    From the website: The 13th European Conference on Pediatric and Neonatal Mechanical Ventilation will again be in Montreux (Switzerland), which will continue to provide the unique and ideal environment for our meeting. As in previous year, thematic sessions include lecturers by key experts and wellknown speakers on various topics related to ventilation and respiratory failure in newborns and children. With the previous very positive and exciting experience integrating nursing in the educational program. http://www.epnv-montreux.org/
  17. One of my very early posts on this blog pertained to my fascination with an Israeli strategy of monitoring end tidal CO2 in place of drawing blood gases. Please see A Strategy to Minimize Blood Sampling in ventilated premature and term infants. The gist of this strategy is that by sampling distal CO2 measurements near the carina you obtain a non diluted sample of CO2 as compared to the traditional proximal end tidal measurement. The authors have shown this to be highly accurate compared to comparable arterial samples during both conventional and high frequency oscilatory ventilation. T
  18. A one day study day covering hot topics in Neonatal ventilation Organised by the Evelina London Children's Hospital and King's College London Details: http://www.guysandstthomasevents.co.uk/paediatrics-training/neonatal-ventilation-updates-hot-topics-and-workshops/ A4 flyer - Neonatal Ventilation 2014 - low res.pdf
  19. This article was recently published in ADC, a systematic review about volume-targeted vs pressure-limited ventilation. The message is that volume-targeting has advantages, as this mode is associated with... Personal reflection: finally there is enough research data to show that volume-targeting seems to be superior over pressure-limited ventilation there are a lot of less good research out there; only 18 of 59 potentially relevant studies were included in this review the authors of this systematic review are not the "usual suspects" (guess whom!) - but a research group in Chin
  20. Go to www.neonatalpneumologynaples.it and check the program !! We welcome you to join a high rank scientific meeting in a world class tourist destination Latest updates in Resuscitation Ventilation Lung ultrasound ... and much more !! Naples, Italy APRIL 11th and 12th, 2014
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