Introduction: Recent reports have raised concerns of cardiorespiratory deterioration in some infants receiving respiratory support at birth. We aimed to independently determine whether respiratory... Show moreIntroduction: Recent reports have raised concerns of cardiorespiratory deterioration in some infants receiving respiratory support at birth. We aimed to independently determine whether respiratory support with a facemask is associated with a decrease in heart rate (HR) in some late-preterm and term infants. Methods: Secondary analysis of data from infants born at & GE;32(+0) weeks of gestation at 2 perinatal centres in Melbourne, Australia. Change in HR up to 120 s after facemask placement, measured using 3-lead electrocardiography, was assessed every 3 s until 60 s and every 5 s thereafter from video recordings. Results: In the 15 s after facemask placement, 10/68 (15%) infants had a decrease in mean HR by >10 beats per minute (bpm) compared with their individual baseline mean HR in the 15 s before facemask placement. In 4 (6%) infants, HR decreased to <100 bpm. Nine out of 68 (13%) infants had an increase in mean HR by >10 bpm; 7 of these infants had a baseline HR <120 bpm. In univariable comparisons, the following characteristics were found not to be risk factors for a decrease in HR by >10 bpm: prematurity; type of respiratory support; hypoxaemia; early cord clamping; mode of birth; HR <120 bpm before mask placement. Six out of 63 infants (10%) who had HR & GE;120 bpm after facemask placement had a late decrease in HR to Conclusion: Facemask respiratory support at birth is temporally associated with a decrease in HR in a subset of late-preterm and term infants. Show less
Most preterm infants need respiratory support and extra oxygen during their admission to the neonatal intensive care. The amount of oxygen required can fluctuate a lot. Bedside staff frequently... Show moreMost preterm infants need respiratory support and extra oxygen during their admission to the neonatal intensive care. The amount of oxygen required can fluctuate a lot. Bedside staff frequently administer extra oxygen, and when the blood oxygen level is normalised, reduce this extra oxygen carefully. This is a delicate process, a fraction too much or a fraction too little may harm their underdeveloped organs.As one of the first, the LUMC has been titrating oxygen automatically since 2015. In this thesis we investigated the effect of this automatization and how preterm infants can profit from this technology. We found that automated oxygen titration reduced the duration of invasive ventilation, but outcome at two years of age was left unchanged. A new automated oxygen controller from 2018 led to even more improvement. Infants spent more time in the narrow therapeutic range, needed even less intensive respiratory support and developed less retinopathy – a disease of the retina which, when untreated, can lead to blindness.From this thesis we can conclude that there is a short-term benefit from automated oxygen titration and we are moving in the right direction. Further research is needed to make the most out of this technology. Show less
The European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and... Show moreThe European Resuscitation Council has produced these newborn life support guidelines, which are based on the International Liaison Committee on Resuscitation (ILCOR) 2020 Consensus on Science and Treatment Recommendations (CoSTR) for Neonatal Life Support. The guidelines cover the management of the term and preterm infant. The topics covered include an algorithm to aid a logical approach to resuscitation of the newborn, factors before delivery, training and education, thermal control, management of the umbilical cord after birth, initial assessment and categorisation of the newborn infant, airway and breathing and circulation support, communication with parents, considerations when withholding and discontinuing support. Show less
This thesis assesses multiple monitoring modalities that can be used in the peri-operative period to reduce respiratory adverse events associated with the use of anesthetic drugs, particularly... Show moreThis thesis assesses multiple monitoring modalities that can be used in the peri-operative period to reduce respiratory adverse events associated with the use of anesthetic drugs, particularly opioids and neuromuscular blocking drugs. Monitors of analgesia, neuromuscular block and ventilation are studied in both healthy volunteers and surgical patient populations to assess proof of concept, efficacy, feasibility of clinical use and effect on clinical outcomes. Show less
Background Acute respiratory distress syndrome (ARDS) is caused by rapid-onset (within hours) acute inflammatory processes in lung tissue, and it is a life-threatening condition with high mortality... Show moreBackground Acute respiratory distress syndrome (ARDS) is caused by rapid-onset (within hours) acute inflammatory processes in lung tissue, and it is a life-threatening condition with high mortality. The treatment of ARDS to date is focused on the prevention of further iatrogenic damage of the lung rather than the treatment of the initial inflammatory process. Several preclinical studies have revealed a beneficial effect of iloprost on the control of pulmonary inflammation, and in a small number of patients with ARDS, iloprost treatment resulted in improved oxygenation. Therefore, we plan to conduct a large multicenter trial to evaluate the effect of iloprost on ARDS. Methods The Therapeutic Iloprost during ARDS trial (ThIlo trial) is a multicenter, randomized, single blinded, clinical phase II trial assessing the efficacy of inhaled iloprost for the prevention of the development and progression of ARDS in critically ill patients. One hundred fifty critically ill patients suffering from acute ARDS will be treated either by nebulized iloprost or NaCl 0.9% for 5 days. Blood samples will be drawn at defined time points to elucidate the serum levels of iloprost and inflammatory markers during treatment. Mechanical ventilation will be standardized. In follow-up visits at days 28 and 90 as well as 6 months after enrollment, functional status according to the Barthel Index and a health care-related questionnaire, and frailty (Vulnerable Elders Survey) will be evaluated. The primary endpoint is the improvement of oxygenation, defined as the ratio of PaO2/FiO(2). Secondary endpoints include 90-day all-cause mortality, Sequential Organ Failure Assessment scores during the study period up to day 90, the duration of mechanical ventilation, the length of intensive care unit (ICU) stay, ventilator-associated pneumonia, delirium, ICU-acquired weakness, and discharge localization. The study will be conducted in three university ARDS centers in Germany. Discussion The results of the ThIlo trial will highlight the anti-inflammatory effect of iloprost on early inflammatory processes during ARDS, resulting in the improvement of outcome parameters in patients with ARDS. Show less
At birth, the lungs of preterm infants are most vulnerable. Current recommendations in respiratory support at birth are based on few data and little distinction has been made between term and... Show moreAt birth, the lungs of preterm infants are most vulnerable. Current recommendations in respiratory support at birth are based on few data and little distinction has been made between term and preterm infants. The aim was to gather data that could lead to a better understanding of spontaneous breathing and improvement of the respiratory support of preterm infants at birth. We report that preterm infants at birth use expiratory braking and breath holds to create and defend their functional residual capacity (FRC). It is possible we should mimic these strategies when respiratory support is needed. Applying positive end expiratory pressure (CPAP) in spontaneous breathing preterm infants at birth is feasible and not detrimental, providing early surfactant is given. Experimental studies in this thesis showed that applying positive end expiratory pressure is essential for creating and maintaining FRC during ventilation of preterm infants at birth. Also, an initial sustained inflation of 10-20 seconds at birth creates an immediate FRC and more uniform lung aeration. Combining these strategies has led to a more efficient approach in preterm infants than repeated manual inflations with a self-inflating bag and mask. This thesis contributed to the accumulating evidence for a different approach than currently recommended. Show less
