Pediatric pulmonology
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Pediatric pulmonology · Jan 2002
ReviewPermissive hypercapnia in neonates: the case of the good, the bad, and the ugly.
Advances in neonatology have resulted in an increase in the absolute number of survivors with chronic lung disease (CLD), though its overall incidence has not changed. Though the single most important high-risk factor for CLD is prematurity, the focus of attention has recently changed over to minimizing the impact of other two risk factors: baro/volutrauma related to mechanical ventilation, and oxygen toxicity. Permissive hypercapnia (PHC) or controlled ventilation is a strategy that minimizes baro/volutrauma by allowing relatively high levels of arterial CO(2), provided the arterial pH does not fall below a preset minimal value. ⋯ Further prospective trials are needed to study the definition, safety and efficacy of PHC in ventilated preterm and term neonates. However, designing disease/gestational-postnatal age-specific clinical trials of PHC will be difficult in neonates, given the diverse pathophysiology of their diseases and the various ventilatory modes/variables currently available. The potential benefits and adverse effects of PHC are reviewed, and its relationship to current ventilatory strategies like synchronized mechanical ventilation and high-frequency ventilation in high-risk neonates is briefly discussed.
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Pediatric pulmonology · Jan 2002
Comparative StudyEffects of partial liquid ventilation with FC-77 on acute lung injury in newborn piglets.
Partial liquid ventilation (PLV) with various types of perfluorochemicals (PFC) has been shown to be beneficial in treating acute lung injury. FC-77 is a type of PFC with relatively high vapor pressure and evaporative losses during PLV. This study tested the hypothesis that using FC-77 for PLV with hourly replacement is effective in treating acute lung injury. ⋯ In contrast, after acute lung injury, low lung compliance, abnormal gas exchange, acidosis, and inadequate oxygenation significantly improved in the Lavage-PLV group. Histological analysis of these 3 study groups revealed that the Lavage-CMV group had the highest lung injury score and the Control group had the lowest. These results suggest that, in comparison to CMV, PLV with FC-77 and hourly replacement of FC-77 promotes more favorable pulmonary mechanics, gas exchange, oxygenation, and lung histology in a piglet model of acute lung injury.