Resp Care
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Extracorporeal membrane oxygenation (ECMO) is a form of cardiopulmonary bypass adapted for long-term use. Blood is drained from the patient, pumped through an artificial lung or membrane where gas exchange is augmented, and then re-infused back to the patient. ECMO provides support for the neonate with severe respiratory failure so that potentially deleterious ventilator settings can be minimized and the disease process given time to resolve. Survival rates and long-term neurodevelopmental outcomes in newborns supported with ECMO for hypoxemic respiratory failure remain favorable, although the use of ECMO has decreased in the most recent decade because of the availability of alternative treatment options.
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The use of oxygen in the treatment of neonates with respiratory distress has been reported for more than a century. Oxygen therapy is generally titrated to one or more measures of blood oxygenation and administered to reverse or prevent hypoxia. Individual responses to oxygen therapy vary greatly, depending on the particular cause of hypoxia and the degree of impairment. ⋯ New and innovative ways to deliver and monitor this therapy have improved outcomes. Despite this vast experience there still remain some unanswered questions regarding the use of oxygen in the neonatal environment. Nonetheless, oxygen is a major staple in our treatment arsenal for neonates.
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Surfactant-replacement therapy is a life-saving treatment for preterm infants with respiratory distress syndrome, a disorder characterized by surfactant deficiency. Repletion with exogenous surfactant decreases mortality and thoracic air leaks and is a standard practice in the developed world. ⋯ Two of these disorders, meconium aspiration syndrome and bronchopulmonary dysplasia, might also be amenable to surfactant-replacement therapy. This paper discusses the use of surfactant-replacement therapy beyond respiratory distress syndrome and examines the evidence to date.