Tit Bits of Refractory hypoxemia & Journey of ventilator care

 

Much progress has been made in the treatment of neonatal respiratory failure over the past few decades. In particular, antenatal steroids and exogenous surfactant replacement have decreased neonatal mortality and morbidity in premature infants(2), (3), (4). However, lung injury and pulmonary morbidities secondary to mechanical ventilation remain an ongoing problem in the care of premature infants and refractory hypoxemia in infants. Of utmost concern, chronic lung disease (CLD) develops in up to one third of preterm infants who have respiratory distress syndrome (RDS) who receive positive pressure mechanical ventilation HFOV-data suggest that early use of high-frequency ventilation, compared with conventional ventilation; high-frequency oscillatory ventilation is not associated with a poorer neuromotor outcome, rather in few studies early use rather than rescue use has been proven to be having less neuromotor insult at 2 years follow up(1).

There are many randomized control trials available now in today’s era of evidence based medicine, which says improved gas exchange and less treatment failure with HFOV, both in the patients initially allocated to HFOV as a primary mode and in those that failed conventional CMV and crossed over to HFOV too. There was no difference in the incidence of chronic lung disease, IVH, or death between the HFOV & CMV but hospital stay and ICU stay was markedly reduced in HFOV Group(5). Cases like PPHN, air leak syndrome and Congenital diaphragmatic hernia (CDH) claim much better results and response with HFOV when used alone or with Nitric oxide therapy in selected scenarios.

 

In all of above mentioned 4 cases; a considerable benefit of capillary ABG Program was utilized. Capillary ABG for neonates is a well proven method in all developed countries as method of choice in doing ABG is these tiny babies avoiding multiple peripheral arterial pricks. Its unique feature of full panel ABG analysis with lactate and electrolytes in just 60 micro L blood, requiring no additional cost gives a relief to clinician as well as Neonate. Sooner As a next step CIMS kids-Department of pediatric and neonatal critical care is going to support such kind of above said neonates and infants with Nitric oxide therapy in near future.

References:-

  • Neuromotor outcome at 2 years of very preterm infants who were treated with high-frequency oscillatory ventilation or conventional ventilation for neonatal respiratory distress syndrome. Truffert P – Pediatrics – 01-APR-2007; 119(4): e860-5
  • Liggins G.C., Howie R.N.: A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 50. 515-525.1972; Citation
  • Crowley P.A.: Antenatal corticosteroid therapy: a meta-analysis of the randomized trials, 1972 to 1994. Am J ObstetGynecol 173. 322-335.1995;
  • Soll R.F.: Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2. 2000; CD000511
  • Clark R.H., Yoder B.A., Sell M.S.: Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr 124. 447-454.1993
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CIMS GlobL Healthcare Excellence Awards 2018

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CIMS Family is honoured to be the recipient of “Among Best Hospital (Cardiology & Oncology) in Gujarat” on October 27, 2018 at the “Prime Time Global Healthcare Excellence Awards 2018”, New Delhi. A very special thanks to our CIMS Staff for their commitment and the patients who have always trusted us. CIMS GlobL Healthcare Excellence Awards 2018

CIMS Hospital has been awarded the Certificate of Excellence as the Best Multispecialty Hospital in Gujarat

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Felicitation Ceremony of Heart Transplant Donors and Recipients held in the presence of Honorable Chief Minister of Gujarat, Shri Vijay Rupani, CIMS cardiac and heart tranplantation doctors by CIMS Hospital.

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Felicitation Ceremony of Heart Transplant Donors and Recipients held in the presence of Honorable Chief Minister of Gujarat, Shri Vijay Rupani, CIMS cardiac and heart tranplantation doctors by CIMS Hospital.