This document discusses the use of supplemental oxygen during resuscitation of preterm infants. It notes that while oxygen is necessary for resuscitation, high concentrations can cause oxidative stress and organ damage. The optimal amount of oxygen to use initially without sensors is unclear. The document then summarizes guidelines from the Spanish Society of Neonatology for titrating oxygen levels based on heart rate, breathing effort and oxygen saturation levels during resuscitation of preterm infants.
This document discusses care of children requiring long-term ventilation. It begins with objectives which include discussing incidence, goals, modes of ventilation, guidelines, monitoring, weaning, complications and nursing management. It then covers incidence rates, the difference between pediatric and adult respiratory systems, types of respiratory failure, functions and definitions related to mechanical ventilation. Various modes of ventilation are described along with initial settings, adjustments, weaning priorities and criteria for extubation. Monitoring, complications and troubleshooting are also addressed. Nursing management is a multidisciplinary team approach. Bundles are discussed as a way to ensure delivery of standard care and assess interventions.
This document provides information on the management of patients on mechanical ventilation. It discusses the indications for mechanical ventilation including inadequate oxygenation and ventilation. It then covers the mechanisms of oxygen transport and various causes of inadequate oxygenation and perfusion. The document outlines the purposes of ventilation and procedures for initiation and settings of mechanical ventilation including modes, parameters, and monitoring of patients. It discusses potential problems during ventilation and goals of ventilation. Finally, the document reviews weaning from mechanical ventilation.
Approaches to non invasive respiratory support in preterm - Dr Karthik Nageshkarthiknagesh
This document discusses various approaches to non-invasive respiratory support for preterm infants, including nasal continuous positive airway pressure (NCPAP), high-flow nasal cannula (HFNC), nasal intermittent mandatory ventilation (NIMV), and neurally adjusted ventilatory assist (NAVA). While non-invasive approaches can reduce the need for intubation and invasive ventilation, none have been shown to decrease the risk of bronchopulmonary dysplasia. The benefits and risks of each approach are described.
This document provides guidance on mechanical ventilation and intubation for neonates. It discusses:
- Common causes of neonatal mortality including preterm birth, sepsis/pneumonia, asphyxia, and others.
- Differences in adult vs. neonatal resuscitation protocols, with neonatal following the sequence of airway, breathing, circulation.
- Steps for neonatal resuscitation including providing warmth, positioning, drying, stimulating breathing, providing oxygen and assisting ventilation.
- Indications for intubation including apnea/gasping, heart rate below thresholds despite ventilation, and need for chest compressions or drugs.
Pre-oxygenation is: safe, simple, cheap, effective, well-tolerated. This article provides a compelling argument in favour of pre-oxygenation prior to all general anaesthesia.
This document provides guidance on neonatal ventilation including indications for mechanical ventilation, types of ventilator modes, and recommendations for volume-targeted ventilation. It discusses the benefits of synchronized modes that support spontaneous breathing like assisted control and pressure support ventilation over non-synchronized modes. It also outlines the advantages of volume-targeted ventilation compared to pressure-limited ventilation, and provides clinical guidelines for initiating and adjusting volume-targeted ventilation in neonates.
This document provides information about mechanical ventilation in neonates from the NICU at Al Shifaa Hospital in Gaza. It discusses [1] the goals and indications for mechanical ventilation in neonates, [2] procedures for intubation and setting appropriate ventilator settings, and [3] concepts of lung physiology and mechanics relevant to neonatal ventilation. The document is intended to guide clinicians on best practices for mechanically ventilating neonates.
This document discusses care of children requiring long-term ventilation. It begins with objectives which include discussing incidence, goals, modes of ventilation, guidelines, monitoring, weaning, complications and nursing management. It then covers incidence rates, the difference between pediatric and adult respiratory systems, types of respiratory failure, functions and definitions related to mechanical ventilation. Various modes of ventilation are described along with initial settings, adjustments, weaning priorities and criteria for extubation. Monitoring, complications and troubleshooting are also addressed. Nursing management is a multidisciplinary team approach. Bundles are discussed as a way to ensure delivery of standard care and assess interventions.
This document provides information on the management of patients on mechanical ventilation. It discusses the indications for mechanical ventilation including inadequate oxygenation and ventilation. It then covers the mechanisms of oxygen transport and various causes of inadequate oxygenation and perfusion. The document outlines the purposes of ventilation and procedures for initiation and settings of mechanical ventilation including modes, parameters, and monitoring of patients. It discusses potential problems during ventilation and goals of ventilation. Finally, the document reviews weaning from mechanical ventilation.
Approaches to non invasive respiratory support in preterm - Dr Karthik Nageshkarthiknagesh
This document discusses various approaches to non-invasive respiratory support for preterm infants, including nasal continuous positive airway pressure (NCPAP), high-flow nasal cannula (HFNC), nasal intermittent mandatory ventilation (NIMV), and neurally adjusted ventilatory assist (NAVA). While non-invasive approaches can reduce the need for intubation and invasive ventilation, none have been shown to decrease the risk of bronchopulmonary dysplasia. The benefits and risks of each approach are described.
This document provides guidance on mechanical ventilation and intubation for neonates. It discusses:
- Common causes of neonatal mortality including preterm birth, sepsis/pneumonia, asphyxia, and others.
- Differences in adult vs. neonatal resuscitation protocols, with neonatal following the sequence of airway, breathing, circulation.
- Steps for neonatal resuscitation including providing warmth, positioning, drying, stimulating breathing, providing oxygen and assisting ventilation.
- Indications for intubation including apnea/gasping, heart rate below thresholds despite ventilation, and need for chest compressions or drugs.
Pre-oxygenation is: safe, simple, cheap, effective, well-tolerated. This article provides a compelling argument in favour of pre-oxygenation prior to all general anaesthesia.
This document provides guidance on neonatal ventilation including indications for mechanical ventilation, types of ventilator modes, and recommendations for volume-targeted ventilation. It discusses the benefits of synchronized modes that support spontaneous breathing like assisted control and pressure support ventilation over non-synchronized modes. It also outlines the advantages of volume-targeted ventilation compared to pressure-limited ventilation, and provides clinical guidelines for initiating and adjusting volume-targeted ventilation in neonates.
This document provides information about mechanical ventilation in neonates from the NICU at Al Shifaa Hospital in Gaza. It discusses [1] the goals and indications for mechanical ventilation in neonates, [2] procedures for intubation and setting appropriate ventilator settings, and [3] concepts of lung physiology and mechanics relevant to neonatal ventilation. The document is intended to guide clinicians on best practices for mechanically ventilating neonates.
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
The document discusses mechanical ventilation in neonates. It provides a brief history of mechanical ventilation and describes various modes of ventilation including positive pressure ventilation. Key aspects of intubation and ventilation such as indications, procedures, settings and complications are outlined. Lung physiology considerations specific to neonates such as compliance, resistance and time constant are also reviewed.
Mechanical ventilation provides respiratory support through invasive means. The goals are to optimize gas exchange and clinical status with minimum pressures and oxygen levels. Initial settings for ventilators include PIP, PEEP, rate, FiO2, Ti, I:E ratio, flow rate and MAP. Parameters are adjusted based on the infant's condition and response to improve synchrony and reduce complications like air leaks. Continuous monitoring is needed to optimize ventilation support safely.
This document discusses various causes of respiratory distress in newborns, including transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and neonatal pneumonia. It provides details on the signs and symptoms, risk factors, diagnosis, and management of each condition. For TTN, it notes the risk factors include premature birth or c-section without labor. For RDS, it explains that surfactant deficiency in preterm infants is the primary cause. For neonatal pneumonia, it identifies the most common causative organisms and states diagnosis is based on clinical, radiographic, and microbiological findings.
25. basics of mechanical ventilation in neonatesAyman Rezk
This document provides an overview of mechanical ventilation in neonates. It discusses indications for mechanical ventilation, initial ventilator settings, monitoring the infant, weaning from ventilation, complications, and adjusting settings based on blood gas results. The goal is to optimize gas exchange while using the lowest possible oxygen and ventilator pressures. Settings are adjusted as needed based on the infant's condition and blood gas levels.
This document discusses mechanical ventilation strategies and considerations for neonates. It covers:
- Unique challenges in neonatal ventilation compared to older children due to transitional circulation, compliant chest walls, and immature respiratory control.
- Goals of mechanical ventilation including safety, comfort, and liberation from the ventilator.
- Manipulating variables like inspiratory pressure, PEEP, flow rates, and rates to optimize gas exchange and lung volumes while minimizing injury.
- Complications that can arise and how to monitor patients, troubleshoot issues, and wean from the ventilator. Initial strategies are outlined for different clinical scenarios.
What's new in critical care of the burn injured patientanestesiahsb
This document summarizes recent advances in critical care management that have contributed to declining mortality in burn patients. It discusses low-tidal volume ventilation, which reduces ventilator-induced lung injury. It also discusses fluid resuscitation guidelines and efforts to define optimal endpoints. New ventilation strategies like airway pressure release ventilation and high-frequency oscillatory ventilation are presented, though more research is needed on their effectiveness for burns. Overall advances in ventilation management and fluid resuscitation have improved survival for burn patients.
The study aimed to examine respiratory diseases in newborns, especially respiratory distress syndrome (RDS), and the relationship between gestational age, birth weight and RDS. It analyzed 30 newborns admitted to the neonatal intensive care unit and neonatal department from January to February 2008. The findings were that RDS predominantly affects preterm infants under 32 weeks gestation. Treatment for RDS included surfactant therapy, CPAP, ventilation and antibiotics. Combinations and durations of antibiotics depended on the diagnosis and severity of the condition.
Rapid sequence induction and intubation (RSII) is a technique used to minimize the risk of pulmonary aspiration by rapidly inducing unconsciousness and paralysis before intubating the trachea. Key elements of RSII include pre-oxygenating the patient, administering sedative and neuromuscular blocking agents to quickly induce unconsciousness and paralysis, applying cricoid pressure, and promptly intubating the trachea with minimal ventilation. Indications for RSII include patients with full stomachs or gastrointestinal pathology who are at higher risk of aspiration. Contraindications include total airway obstruction or loss of airway landmarks. Potential complications include difficult or failed airway, hypoxia, hypotension,
The document discusses Bronchopulmonary Dysplasia (BPD), a chronic lung disease that develops in premature infants requiring oxygen therapy and mechanical ventilation. It covers the background, pathophysiology, stages, frequency, complications and medical management of BPD. The medical management includes strategies to prevent lung injury through gentle ventilation, optimizing nutrition and oxygen therapy, using medications like diuretics and bronchodilators, and facilitating weaning from oxygen and ventilator support.
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
Protective ventilation, the way I do it - Anders Larsson - SSAI2017scanFOAM
A talk by Anders Larsson at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Hippocrates first described endotracheal intubation in the 5th century BC. Mechanical ventilation progressed through the centuries with innovations like Paracelsus using bellows in 1530 and Vesalius recognizing artificial respiration through tracheostomy in dogs in the 16th century. The development of positive pressure ventilation in the 1950s helped greatly during polio epidemics. Key events included the iron lung in 1929 and intensive use of positive pressure ventilation in Scandinavia and the US in the 1950s. The document outlines the historical aspects and developments of mechanical ventilation from ancient times through the modern era.
This document provides guidance on positive pressure ventilation for newborn resuscitation. It discusses when PPV should be initiated, components of PPV including PIP, PEEP and flow rate. Three main types of resuscitation devices are described - self-inflating bag, flow-inflating bag and T-piece resuscitator. Key steps for preparing the resuscitation equipment and positioning the newborn are outlined. Intubation is discussed as an alternative to mask ventilation in certain situations. The document concludes with recommendations on oxygen use and monitoring during newborn resuscitation.
A preterm newborn developed respiratory distress soon after birth, with signs including grunting and cyanosis. Evaluation found respiratory distress syndrome (RDS). The baby was treated with nasal CPAP, surfactant, and mechanical ventilation. RDS is caused by surfactant deficiency in premature infants, resulting in alveolar collapse and impaired gas exchange. Management includes respiratory support, surfactant replacement therapy, and care to prevent complications.
This document discusses guidelines for weaning patients from mechanical ventilation. It begins by defining weaning as the process of withdrawing ventilatory support, which can be done abruptly or gradually. Approximately 75% of patients can be weaned abruptly if their underlying condition has improved. The remaining 25% require a more gradual weaning process. Common weaning techniques discussed include T-piece trials, pressure support ventilation, and synchronized intermittent mandatory ventilation. Predictors of weaning success mentioned include the rapid shallow breathing index and daily screening of patients' condition and respiratory status. The document emphasizes that weaning should only begin once the underlying illness necessitating ventilation has significantly improved.
The document discusses challenges in health social networks and the need to better understand "ePatients". It proposes evaluating ePatients' characteristics like education, age, skills, and expectations to develop a typology. An approach is outlined using surveys, focus groups, and validated scales to assess eHealth literacy and patient activation. Combining these could identify ideal, digital citizen, analog, and risk ePatient types to help engage the right users with the right social media tools. The goal is personalized ePatient interventions for personalized medicine.
Paper Merche Serrano - Guía metabólica: empowerment through health 2.0 tools ...WTHS
Guiametabolica.org is a Spanish language website that aims to empower patients with inborn errors of metabolism (IEM) through providing health information and online support. The website offers clinical information about IEMs, tips for daily living, recipes, stories for children, and an online community for asking questions and sharing experiences. Over 157,000 visits to the site have come primarily from Latin America. Preliminary analysis of questionnaires from 65 users found that most are caregivers of IEM patients and that the site has improved users' sense of empowerment by reducing feelings of loneliness and improving self-efficacy. The authors conclude that websites like Guiametabolica.org that provide online support and communities
This document discusses strategies for optimizing preoxygenation prior to endotracheal intubation. It notes that conventional preoxygenation techniques provide safe intubation for most ED patients but that a subset may still desaturate. To safely intubate this higher risk group, the document recommends optimizing preoxygenation through techniques like non-invasive ventilation, apneic oxygenation through nasal cannula, positioning patients in a head-up position, and breaking the sequence of rapid sequence intubation administration. The goal is to prevent deoxygenation and extend the safe apneic period for patients undergoing endotracheal intubation.
The document discusses mechanical ventilation in neonates. It provides a brief history of mechanical ventilation and describes various modes of ventilation including positive pressure ventilation. Key aspects of intubation and ventilation such as indications, procedures, settings and complications are outlined. Lung physiology considerations specific to neonates such as compliance, resistance and time constant are also reviewed.
Mechanical ventilation provides respiratory support through invasive means. The goals are to optimize gas exchange and clinical status with minimum pressures and oxygen levels. Initial settings for ventilators include PIP, PEEP, rate, FiO2, Ti, I:E ratio, flow rate and MAP. Parameters are adjusted based on the infant's condition and response to improve synchrony and reduce complications like air leaks. Continuous monitoring is needed to optimize ventilation support safely.
This document discusses various causes of respiratory distress in newborns, including transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and neonatal pneumonia. It provides details on the signs and symptoms, risk factors, diagnosis, and management of each condition. For TTN, it notes the risk factors include premature birth or c-section without labor. For RDS, it explains that surfactant deficiency in preterm infants is the primary cause. For neonatal pneumonia, it identifies the most common causative organisms and states diagnosis is based on clinical, radiographic, and microbiological findings.
25. basics of mechanical ventilation in neonatesAyman Rezk
This document provides an overview of mechanical ventilation in neonates. It discusses indications for mechanical ventilation, initial ventilator settings, monitoring the infant, weaning from ventilation, complications, and adjusting settings based on blood gas results. The goal is to optimize gas exchange while using the lowest possible oxygen and ventilator pressures. Settings are adjusted as needed based on the infant's condition and blood gas levels.
This document discusses mechanical ventilation strategies and considerations for neonates. It covers:
- Unique challenges in neonatal ventilation compared to older children due to transitional circulation, compliant chest walls, and immature respiratory control.
- Goals of mechanical ventilation including safety, comfort, and liberation from the ventilator.
- Manipulating variables like inspiratory pressure, PEEP, flow rates, and rates to optimize gas exchange and lung volumes while minimizing injury.
- Complications that can arise and how to monitor patients, troubleshoot issues, and wean from the ventilator. Initial strategies are outlined for different clinical scenarios.
What's new in critical care of the burn injured patientanestesiahsb
This document summarizes recent advances in critical care management that have contributed to declining mortality in burn patients. It discusses low-tidal volume ventilation, which reduces ventilator-induced lung injury. It also discusses fluid resuscitation guidelines and efforts to define optimal endpoints. New ventilation strategies like airway pressure release ventilation and high-frequency oscillatory ventilation are presented, though more research is needed on their effectiveness for burns. Overall advances in ventilation management and fluid resuscitation have improved survival for burn patients.
The study aimed to examine respiratory diseases in newborns, especially respiratory distress syndrome (RDS), and the relationship between gestational age, birth weight and RDS. It analyzed 30 newborns admitted to the neonatal intensive care unit and neonatal department from January to February 2008. The findings were that RDS predominantly affects preterm infants under 32 weeks gestation. Treatment for RDS included surfactant therapy, CPAP, ventilation and antibiotics. Combinations and durations of antibiotics depended on the diagnosis and severity of the condition.
Rapid sequence induction and intubation (RSII) is a technique used to minimize the risk of pulmonary aspiration by rapidly inducing unconsciousness and paralysis before intubating the trachea. Key elements of RSII include pre-oxygenating the patient, administering sedative and neuromuscular blocking agents to quickly induce unconsciousness and paralysis, applying cricoid pressure, and promptly intubating the trachea with minimal ventilation. Indications for RSII include patients with full stomachs or gastrointestinal pathology who are at higher risk of aspiration. Contraindications include total airway obstruction or loss of airway landmarks. Potential complications include difficult or failed airway, hypoxia, hypotension,
The document discusses Bronchopulmonary Dysplasia (BPD), a chronic lung disease that develops in premature infants requiring oxygen therapy and mechanical ventilation. It covers the background, pathophysiology, stages, frequency, complications and medical management of BPD. The medical management includes strategies to prevent lung injury through gentle ventilation, optimizing nutrition and oxygen therapy, using medications like diuretics and bronchodilators, and facilitating weaning from oxygen and ventilator support.
Mechanical ventilation ppt including airway, ventilator, tubings and connections, nursing management, trouble shooting common problems and issues, suctioning etc.
Protective ventilation, the way I do it - Anders Larsson - SSAI2017scanFOAM
A talk by Anders Larsson at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All of the conference content can be found here: https://scanfoam.org/ssai2017/
Developed in collaboration between scanFOAM, SSAI and SFAI.
Hippocrates first described endotracheal intubation in the 5th century BC. Mechanical ventilation progressed through the centuries with innovations like Paracelsus using bellows in 1530 and Vesalius recognizing artificial respiration through tracheostomy in dogs in the 16th century. The development of positive pressure ventilation in the 1950s helped greatly during polio epidemics. Key events included the iron lung in 1929 and intensive use of positive pressure ventilation in Scandinavia and the US in the 1950s. The document outlines the historical aspects and developments of mechanical ventilation from ancient times through the modern era.
This document provides guidance on positive pressure ventilation for newborn resuscitation. It discusses when PPV should be initiated, components of PPV including PIP, PEEP and flow rate. Three main types of resuscitation devices are described - self-inflating bag, flow-inflating bag and T-piece resuscitator. Key steps for preparing the resuscitation equipment and positioning the newborn are outlined. Intubation is discussed as an alternative to mask ventilation in certain situations. The document concludes with recommendations on oxygen use and monitoring during newborn resuscitation.
A preterm newborn developed respiratory distress soon after birth, with signs including grunting and cyanosis. Evaluation found respiratory distress syndrome (RDS). The baby was treated with nasal CPAP, surfactant, and mechanical ventilation. RDS is caused by surfactant deficiency in premature infants, resulting in alveolar collapse and impaired gas exchange. Management includes respiratory support, surfactant replacement therapy, and care to prevent complications.
This document discusses guidelines for weaning patients from mechanical ventilation. It begins by defining weaning as the process of withdrawing ventilatory support, which can be done abruptly or gradually. Approximately 75% of patients can be weaned abruptly if their underlying condition has improved. The remaining 25% require a more gradual weaning process. Common weaning techniques discussed include T-piece trials, pressure support ventilation, and synchronized intermittent mandatory ventilation. Predictors of weaning success mentioned include the rapid shallow breathing index and daily screening of patients' condition and respiratory status. The document emphasizes that weaning should only begin once the underlying illness necessitating ventilation has significantly improved.
The document discusses challenges in health social networks and the need to better understand "ePatients". It proposes evaluating ePatients' characteristics like education, age, skills, and expectations to develop a typology. An approach is outlined using surveys, focus groups, and validated scales to assess eHealth literacy and patient activation. Combining these could identify ideal, digital citizen, analog, and risk ePatient types to help engage the right users with the right social media tools. The goal is personalized ePatient interventions for personalized medicine.
Paper Merche Serrano - Guía metabólica: empowerment through health 2.0 tools ...WTHS
Guiametabolica.org is a Spanish language website that aims to empower patients with inborn errors of metabolism (IEM) through providing health information and online support. The website offers clinical information about IEMs, tips for daily living, recipes, stories for children, and an online community for asking questions and sharing experiences. Over 157,000 visits to the site have come primarily from Latin America. Preliminary analysis of questionnaires from 65 users found that most are caregivers of IEM patients and that the site has improved users' sense of empowerment by reducing feelings of loneliness and improving self-efficacy. The authors conclude that websites like Guiametabolica.org that provide online support and communities
O documento discute os desafios de implementar uma nova política de segurança cibernética em uma organização. A política exigiria novas ferramentas de monitoramento e relatórios regulares, mas enfrentaria resistência de alguns funcionários preocupados com privacidade. O autor sugere abordagens graduais para explicar os benefícios da política e ganhar apoio.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
1. Deadlock dapat dicegah dengan tiga skema: hold and wait, circular wait, dan no preemption.
2. Sistem dalam kasus yang diberikan terjebak dalam deadlock karena proses P2 menggunakan sumber daya R1 yang dituntut oleh proses P0.
3. OS akan memberikan grant printer kepada user y karena memiliki kebutuhan printer terendah, mengamankan sequence penggunaan sumber daya yang aman.
The document summarizes a study on environmental marketing claims made by consumer products. Some key findings include:
- Over 98% of products surveyed in North America committed at least one of the previously identified "Sins of Greenwashing".
- A new seventh sin emerged - the "Sin of Worshiping False Labels", where some marketers exploit consumer demand for third-party certification with fake labels or false suggestions of third-party endorsement.
- Legitimate eco-labeling is increasing, present on 23% of products compared to 14% in a previous study.
- Products making the most environmental claims and being most at risk of greenwashing are toys/baby products, cosmetics
This document summarizes the goals and strategies of the italiansoccernet.blogspot.com website. The goals are to connect with soccer fans worldwide and communicate news about Serie A. The target audience is males and females aged 16-25 in Toronto interested in Italian soccer. Key strategies include blogging about Serie A matches and news, engaging on social media like Facebook and Twitter, and analyzing website performance metrics. The blog has been successful in reaching an international audience and those aged 18-24, but engagement on social media remains low and the blog quality could be improved. Moving forward, strategies include better content, images, and design along with a monthly email newsletter.
The document analyzes how a media product uses conventions of real documentaries. It discusses researching the forms of documentaries, television double page spreads, and radio trailers. It then examines how the created documentary, magazine spread, and radio trailer employ established conventions like a narrative structure, interviews, statistics, shot types, layout, music, and voiceover elements. The product demonstrates an understanding of documentary conventions.
This document contains a collection of short quotes and sayings about life, friendship, love, destiny, and finding meaning or purpose. Some of the quotes discuss appreciating what you have, making the most of unexpected opportunities, and recognizing that events often happen for a reason. Others focus on the importance of true friends who touch your heart, looking together with another in the same direction rather than at each other, and living fully without regret.
Smoking involves inhaling the smoke of burning tobacco in cigarettes, pipes, and cigars. It is both a physical and psychological addiction with serious health consequences. People smoke for various reasons like looking mature, being like friends, relaxing, or dealing with problems. Smoking can cause immediate effects like loss of appetite and coughing as well as long term issues like cancer, impotence, infertility, and early wrinkles. When quitting, it is best to mentally prepare by setting a firm quit date and removing smoking-related items from your home and clothes to avoid smoke smells.
The document summarizes how a magazine review uses and does not use the codes and conventions of existing media texts. It uses a clear title of the reviewed movie, prominent quotes from the movie, a main photograph of an actor to promote their role, and a column layout to keep the text tidy and easy to read. However, it does not include multiple photographs as is typical and uses a single main image due to the color palette.
Mercedes Serrano - Guía metabólica: empowerment through health 2.0 tools in ...WTHS
Presentation of Workshop on Technology for Healthcare and Healthy Lifestyle 2011
Thursday 1st Dec 2011
Session III
http://www.tsb.upv.es/wths2011
También en:
http://es.scribd.com/doc/73819171/Presentacion-Dra-Mercedes-Serrano-Guia-Metabolica-conferencia-Ideagoras-2011
Este documento presenta la candidatura de Miguel Ángel Yerena Ruiz para Presidente Municipal de Puerto Vallarta, Jalisco por el partido PRD. Incluye su biografía, compromisos de campaña y dos proyectos principales: 1) la creación de una unidad deportiva infantil para 10,000 personas con diversas disciplinas y 2) el desarrollo turístico integral de la zona centro con proyectos como un teleférico, museos y parques temáticos.
The Claros Foundation was established in 1992 and provides ENT medical assistance to underdeveloped countries around the world. It has traveled to over 11 countries in Africa, Eastern Europe, and India, performing over 5,000 surgeries. The foundation also provides scholarships for young doctors from developing countries and donates medical equipment to hospitals. It has awarded 24 scholarships for training in otorhinolaryngology since 1998.
This document summarizes guidelines from the International Liaison Committee on Resuscitation regarding neonatal resuscitation. It discusses various aspects of neonatal resuscitation including initial steps, use of supplemental oxygen, management of meconium, ventilation strategies, and use of devices to assist ventilation. For each topic, it summarizes the available evidence and provides treatment recommendations based on the consensus reached.
Mechanical ventilation has been used in neonates since the 1960s and has improved survival rates greatly. The goals of mechanical ventilation are to provide adequate oxygenation and ventilation while minimizing lung injury. Some key aspects of mechanical ventilation include modes like pressure control and patient trigger ventilation. Proper settings of variables like respiratory rate, tidal volume, and pressures are important to optimize ventilation while protecting the lungs.
This document summarizes guidelines from the 7th edition of the Neonatal Resuscitation Program published in 2015. It discusses the incidence of newborns requiring resuscitation, anticipation of resuscitation needs, changes to the NRP flow diagram, levels of evidence for recommendations, and specifics of resuscitation steps including ventilation, chest compressions, and use of medications. Key points include anticipating resuscitation needs based on risk factors, initiating PPV within 60 seconds if needed, using appropriate pressures and oxygen levels during PPV, and administering epinephrine IV if the heart rate is less than 60/minute despite adequate ventilation and chest compressions.
Neonatal resuscitation is a set of interventions to assist newborns after birth with breathing, heart rate and circulation issues. The Neonatal Resuscitation Program provides guidelines for proper resuscitation procedures. The document outlines assessment steps, interventions for inadequate breathing or heart rate like positive pressure ventilation, intubation and chest compressions. It recommends use of pulse oximetry and targeting specific oxygen saturation ranges. Procedures are tailored based on gestational age and other risk factors. The latest guidelines emphasize thermoregulation and update certain practices based on recent evidence.
This case report describes a 25-year-old woman who experienced bronchospasm during anesthetic induction for cochlear implant surgery. After intubation with succinylcholine, she developed difficulty breathing, low carbon dioxide levels, and arterial desaturation. Epinephrine and fluids stabilized her cardiovascularly while wheezing and ventilation improved with bronchodilators and steroids. Testing ruled out allergy to induction agents but a possible non-IgE mediated reaction to succinylcholine. She recovered fully with treatment.
1. The document discusses guidelines for pediatric resuscitation from the International Liaison Committee on Resuscitation, including techniques for positioning, airway management, chest compressions, defibrillation, and post-resuscitation care.
2. Key recommendations include a compression to ventilation ratio of 15:2 for healthcare providers performing two-rescuer CPR, initial and subsequent doses of epinephrine at 10 mcg/kg, and consideration of induced hypothermia and tight glucose control for comatose children after resuscitation.
3. Factors that may indicate further resuscitative efforts are futile include most cardiac arrests associated with blunt trauma or septic shock, while certain characteristics like icy
Respiratory distress is common in preterm infants and can have serious consequences. It is defined as the presence of tachypnea, retractions, or grunting. Common causes include respiratory distress syndrome (RDS) due to surfactant deficiency. Assessment involves evaluating respiratory rate, work of breathing, oxygen needs and chest x-ray findings. Management consists of supportive care including oxygen supplementation, monitoring, antibiotics if indicated. Surfactant replacement therapy improves outcomes in RDS but can increase risk of apnea. Non-invasive respiratory support with CPAP is preferred over mechanical ventilation when possible.
Rapid sequence intubation involves several key steps:
1. Preoxygenation of the patient with 100% oxygen for 3 minutes to establish an oxygen reserve before intubation.
2. Administration of sedatives and neuromuscular blocking agents (NMBAs) to gain control of the airway without risk of aspiration.
3. Placement of the endotracheal tube once paralysis is achieved, confirmed by lack of muscle tone and ability to ventilate if oxygen saturation drops below 90%.
4. Postintubation management including chest x-ray, use of long-acting NMBAs, and sedation to facilitate mechanical ventilation.
The document discusses various topics related to mechanical ventilation including:
1. Ventilation strategies for acute respiratory distress syndrome (ARDS) including low tidal volumes, optimal positive end-expiratory pressure, and prone positioning.
2. Ventilation modes and settings should be tailored to the individual patient's condition and aim to prevent ventilator-induced lung injury.
3. Non-invasive ventilation can be considered for certain patients with COPD or asthma to avoid intubation if criteria are met.
Rapid sequence intubation (RSI) involves the simultaneous administration of an induction agent and neuromuscular blocking drug to facilitate endotracheal intubation. It allows for increased success rates, decreased intubation times, and reduced risks of aspiration, hypoxia, and trauma. The key steps of RSI are preparation, preoxygenation, pretreatment, paralysis with induction, positioning, placement with proof of tube position, and post-intubation management. Confirmation of tube placement involves clinical assessment and mechanical methods like end-tidal CO2 monitoring and ultrasound. Complications can be minimized by adhering to the standardized RSI protocol.
Retropharyngeal Abscess Managed With Ketamine - A Case Report_Crimson PublishersCrimsonPublishersAICS
A one year old male child presented to the pediatrics emergency with difficulty in breathing for the last 10-12 days. Severe inspiratory stridor was present and the accessory muscles of respiration were active. X-ray of lateral view of the neck showed increased soft tissue shadow in front of C2 vertebra suggestive of retropharyngeal abscess. Incision and drainage of retropharyngeal abscess was planned under general anesthesia after perforsming tracheostomy, as an emergency procedure. Intravenous glycopyrrolate 50 micrograms followed by 3 mg of ketamine was given slowly till the patient became calm following which tracheotomy was carried out under local anesthesia achieved by infiltration with lignocaine by the otolaryngologist. After tracheotomy, the patient was given ketamine 5mg intravenously and oxygen: nitrous oxide (50:50) and Sevoflurane 2% through the tracheotomy
tube attached to the breathing circuit with the patient breathing spontaneously. Incision and drainage of the abscess was carried out and 20ml of pus aspirated. We found ketamine to be very useful for sedation while carrying out a tracheotomy in this case.
The document summarizes revisions to the Neonatal Resuscitation Guidelines. It discusses the importance of properly training medical personnel in neonatal resuscitation, as 10% of babies need some intervention at birth and 1% require extensive resuscitation. Key changes include beginning resuscitation of preterm infants <35 weeks with lower oxygen, delaying cord clamping for 30-60 seconds for vigorous babies, and using devices that can provide PEEP for preterm resuscitation. It also covers medication administration, intubation, chest compressions, and thermoregulation of preterm infants.
Neonatal acute respiratory distress syndrome (RDS) is caused by surfactant deficiency in premature infants. Surfactant is produced in the lungs beginning at 24 weeks gestation and helps lower surface tension to prevent alveolar collapse. Preemies are at risk for RDS due to incomplete lung development and surfactant production. Treatment includes supportive care like CPAP, surfactant replacement therapy, and mechanical ventilation if needed. With treatment and lung maturation, symptoms typically improve within 3-5 days.
This document discusses cardiopulmonary resuscitation (CPR) techniques and a study that found a combination of vasopressin, steroids, and epinephrine during CPR led to improved outcomes compared to epinephrine alone. It provides details on performing CPR, including chest compressions, ventilation, positioning, and guidelines for adults, children and infants. Videos are referenced to demonstrate CPR and use of an automated external defibrillator. Potential complications of CPR like rib fractures and gastric insufflation are also mentioned.
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are outlined. Specific induction agents, paralytics, and reversal drugs are also discussed.
This document provides information on rapid sequence intubation (RSI) in adults. It defines RSI as the virtually simultaneous administration of a sedative and neuromuscular blocking agent to facilitate endotracheal intubation while minimizing aspiration risk. The principles of RSI are described, including preparation, preoxygenation, pretreatment, paralysis with induction, protection/positioning, tube placement confirmation, and post-intubation management. Contraindications and advantages of RSI are also outlined.
Respiratory distress syndrome is a life-threatening lung disorder that affects newborns, especially preterm infants. It results from underdeveloped lungs and low surfactant levels. Signs include rapid breathing, grunting, and chest retractions within 6 hours of birth. Treatment involves oxygen therapy, ventilation support if needed, maintaining nutrition/hydration intravenously, and surfactant replacement. With appropriate care, survival rates are 60-80% for infants over 1000g, though complications can include brain/lung issues. Respiratory distress syndrome requires close monitoring and management of respiratory and metabolic acidosis in newborns.
Incidence of oxygen desaturation with intravenous ketaminearbin joshi
The study evaluated the incidence of oxygen desaturation in children undergoing short surgical procedures with intravenous ketamine anesthesia at two hospitals in Nepal. The incidence of desaturation was 10% at one hospital and 16.1% at the other. Basic airway maneuvers like chin lift improved oxygen saturation in most cases who desaturated, with jaw thrust also effective in some cases. No patients required supplemental oxygen or more advanced airway interventions. The study demonstrated that desaturation is common initially after ketamine administration but easily corrected with basic airway techniques.
Rapid sequence intubation (RSI) involves administering sedatives and paralytics to quickly sedate and paralyze a patient to facilitate emergency intubation. It aims to minimize risks of aspiration, trauma, and hypoxia. Proper preparation, pre-oxygenation, pretreatment, paralysis, protection with cricoid pressure, intubation, and post-intubation management are the "seven P's" of RSI. Indications include those at high risk of aspiration. Etomidate or ketamine are commonly used sedatives depending on the patient's condition. Succinylcholine or rocuronium are often used as paralytics. Cricoid pressure protects
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Paper Álvaro Hermida - Gas Control System for Neonates
1. Gas Control System for Neonates
Alvaro Hermida1, Antonio Martínez-Millana2, Marta Aguar Carrascosa3, Max Vento3, Vicente Traver Salcedo2
1
Department of Information Systems and Computation (DSIC), Polytechnic University of Valencia, Spain
ahermida@dsic.upv.es
2
Research Group of Technologies for Health and Wellbeing (TSB), ITACA Institute, Polytechnic University of Valencia, Spain
anmarmil, vtraver@itaca.upv.es
3
Hospital La Fe, Valencia, Spain
maraca@alumni.uv.es, Maximo.Vento@uv.es
Abstract— Preterm infants pose a significant challenge for the
neonatologist: They have an immature antioxidant defense B. Kidney and Heart Damage.
system, but they often need resuscitation at birth, including Vento and colleagues have shown the existence of an
forced ventilation and supplemental oxygen supply. The exponential relationship between a marker of oxidative stress
neonatologist should keep a careful balance to accelerate the (GSSG - oxidized glutathione) and biochemical markers of
establishment of a physiological breathing pattern while
damage at renal tubular level (N-acetyl-glucosaminidase) and
minimizing the amount of oxygen delivered. The REOX
multicenter clinical study is generating the knowledge needed to myocardial (cardiac troponins), 48 hours after birth in infants
optimize the amount of oxygen supplied from the precise resuscitated with higher concentrations of oxygen [5].
moment of birth, when the sensors do not provide yet the reliable
information required to titrate the amount of oxygen using the C. Lung Damage Induced by Unnecessary Lengthening of
resuscitation algorithms. Forced Ventilation.
Although forced ventilation by continuous positive pressure
saves lives, it can also induce lung injury [6], so minimization
I. INTRODUCTION of its duration will improve the prognosis.
At rest, in physiological conditions, human arterial blood is Both experimental models and clinical studies show that a
saturated of oxygen. Most of this oxygen is bound to lower initial oxygen concentration accelerates the
hemoglobin, although a small quantity is just dissolved on the establishment of an effective spontaneous breathing pattern,
blood. The normal percentage of oxygenated hemoglobin as significantly reducing the time of resuscitation [7]. Some
detected by the pulse oximeter (SpO2) ranges between 95% markers of oxidative stress remain high even 28 days after
and 99%. A value under 95% may compromise cellular resuscitation, when 100% oxygen is used.
perfusion, and an SpO2 lower than 90% is defined as acute
respiratory failure.
III. BENEFICIAL ASPECTS OF SUPPLEMENTAL OXYGEN DURING
But before birth, when placental gas exchange in a liquid-
RESUSCITATION.
filled intrauterine environment is the only source of oxygen,
this percentage is as low as 43% [1] [2], rising rapidly after Despite its side effects, the use of a certain amount of
labor, with the onset of spontaneous ventilation after birth, supplemental oxygen may be necessary to successfully
reaching 80-90% in a few minutes [3]. resuscitate an asphyxiated newborn. As Wang and colleagues
The term infants already have a physiological antioxidant demonstrated in their study [8], there is a highly significant
system (developed during the third trimester of pregnancy) probability of failing in the attempt to reach the desired
that allows them to withstand the potentially pro-oxidant state, saturation levels when the resuscitation is started with an
but preterm infants do not yet have these defenses. The oxygen concentration of 21%. Meanwhile, Dawson has
situation worsens when you need to apply resuscitation after published [9] that in her hospital, 92% of the infants under 30
birth, including forced ventilation and supplemental oxygen. weeks of gestation whose resuscitation begun with an oxygen
concentration of 21% required an increase of this
concentration.
II. SIDE EFFECTS OF SUPPLEMENTAL OXYGEN DURING Relatively low oxygen concentrations are sufficient to
RESUSCITATION. ensure a safe resuscitation. Escrig team has shown that the
resuscitation of extremely premature infants (less than 28
A. Decreased Brain Mass. weeks of gestation) can be started safely with an oxygen
In a study with rats, Yis and colleagues have recently concentration of 30%, reaching saturation and heart rates
shown that oxygen concentrations of 80% in the developing similar to those obtained with higher concentrations, while
brain trigger an apoptotic neurodegenerative reaction causing reducing the burden of total oxygen delivered to the patient,
cell death and decreased brain mass [4], with a significant minimizing hyperoxemia and its consequences [10].
reduction of neuronal density.
2. IV. THE ALGORITHM FOR RESUSCITATION FROM THE SPANISH C. Ventilatory support:
SOCIETY OF NEONATOLOGY Continuous positive airway pressure (CPAP) will be
The question about the ideal percentage of supplemental applied from start to all infants ≤ 28 weeks according to the
oxygen affects especially the beginning of resuscitation, when rules of the SEN.
it is necessary to decide the initial amount of added oxygen For prematures of 29 weeks, the ventilatory support will be
(FiO2, Oxygen Inspired Fraction) without having objective individualized according to the FC, respiratory effort, SpO2
information on which to rely. Once the sensors are beginning and color.
to provide quantitative information on the patient's condition, Once initial stabilization is achieved by maintaining a heart
as the degree of blood oxygenation (SpO2) and heart rate rate > 100 bpm, SpO2 > 75% or progressive rise in respiratory
(HR), and the neonatologist observes the patient's response to effort present, CPAP will be delivered using a face mask
resuscitation and stabilization, it is time to apply the connected to the "T" piece at H 5cmH2O.
resuscitation algorithm established by the Spanish Society of If at any time appear bradycardia, maintained apnea,
Neonatology [11] [12] [13]. gasping or SpO2 does not rise gradually, positive pressure
ventilatory support will be applied.
A. Stimulation:
Endotracheal intubation will be considered individually if
The gentle handling of the premature infant in the first assessment is negative after check that the positive pressure
seconds of life is usually enough to start the spontaneous ventilatory support is being correctly applied.
breathing. If not, evaluate the gentle stimulation of the skin in
caudo-cranial direction. D. Oxygen administration:
Changes in the Inspired Oxygen Fraction (FiO2) will
B. Assess the situation:
always be performed in combination with changes in
1) Breathing: - Spontaneous respiration is normally set ventilatory support, after checking the effectiveness of the
between the first and third minute of life. The breathing ventilatory support.
pattern more or less regular basis will maintain a heart rate > If the SpO2 has to be modified (increased or decreased) the
100 bpm, a progressive increase in SpO2 and progressive changes will be in steps of 10% at intervals of 10-30 seconds.
improvement of the color. In extreme situations it is possible to initiate the
- The presence of prolonged apnea, gasping type breathing, administration of oxygen at 100% for any of the groups when
or bradycardia are indications of initiation of ventilatory cardiac massage or administration of medication in the
support. delivery room is needed (HR < 60 bpm for 30 seconds which
does not respond to proper positive pressure ventilation), or
2) Heart: - Assessed by direct auscultation, palpation of when HR < 100 bpm for more than 2 minutes.
central or brachial pulses, pulses at the base of the umbilical
cord or by pulse oximetry. E. Circulatory support:
- An HR > 100 bpm is considered a leading indicator of the Heart rate will be monitored in all patients initially by
effectiveness of the stabilization-resuscitation maneuvers. auscultation or palpation of pulses and then by pulse oximetry.
- In extremely preterm (≤ 26 weeks) consider that the An HR < 100 bpm will be considered bradycardia and
establishment of a HR ≥ 100 bpm physiologically may take 2 extreme bradycardia when HR < 60 bpm.
to 3 minutes. Positive pressure ventilatory support during 30 seconds will
be applied to bradycardia newborns and the situation will then
3) Color and SpO2: - The color is an unreliable indicator be re-evaluated, regardless of the initial FiO2.
for being difficult to assess during the fetal-neonatal transition If the heart rate does not increase over 60 bpm, cardiac
and not be a marker of tissue oxygenation status. massage will be started with a sequence of 3:1 for 30 seconds.
- The saturation by pulse oximetry provides accurate Assess endotracheal intubation at this time. If there is no
information of the oxygenation status in real time and proper response to ventilatory support and cardiac massage,
subsequent changes in response to resuscitation. adrenaline will be administered.
- In non-asphyxiated premature infants, the first
measurements of SpO2 at birth typically range from 40-45%.
Subsequently, these figures rise slowly to 80-85% at 10 V. THE STANDARD SATURATION CURVE OF THE HEALTHY
NEWBORN AS A GUIDE TO DRIVE RESUSCITATION EFFORTS.
minutes after birth.
- When required supplemental oxygen during resuscitation, To achieve a balance between minimizing oxygen load and
the safety range of SpO2 to avoid both hypo as hyperoxemia accelerating the establishment of a "normal" physiological
had been established between 85-93%. breathing pattern, it is necessary to establish a benchmark to
- In preterm infants who require resuscitation at birth, there define the normal pace and "natural" evolution during the first
are no reference ranges, therefore, the assessment of the minutes of life. To this end, studies such as Dawson and
effectiveness of stabilization-resuscitation maneuvers should colleagues [9] have analyzed the evolution of pulse oximetry
be based on the combination of FC, response to stimuli and saturation measured by optical SpO2 during the first 10
rise of the SpO2.
3. minutes of life of hundreds of infants who did not need concentration of 100% can be dangerous, especially in
resuscitation at birth. situations of ischemia followed by reperfusion, where the
accumulation of purine derivatives during ischemia causes the
appearance of large amounts of free radicals in the lung at the
sudden combination with pure oxygen [16].
It is also proven [8] that the natural concentration of 21% is
in most cases insufficient to achieve the target saturations in
an acceptable time.
Once the extremes are discarded, it is still necessary to
reduce the range of initial concentrations where the best
balance can be found. This is the purpouse of our study.
B. Working Hypothesis
"The use of low concentrations of oxygen as the initial
gas mixture during resuscitation of preterm infants of
extremely low birth weight can help reduce the toxicity
due to excess oxygen."
C. Main Objective
Fig. 1 Third, 10th, 25th, 50th, 75th, 90th, and 97th SpO2 percentiles for term
infants at ≥ 37 weeks of gestation with no medical intervention after birth.
The REOX trial (EUDRACT: 2008-005047-42) whose
promoter and principal investigator is Dr. Maximo Vento
Torres (Hospital La Fe, Consellería de Sanitat de la
Generalitat Valenciana), aims to reduce the cited range by
comparing the results of two intermediate concentrations: 30%
and 60%.
Initial O2 O2 relative Group
concentration concentration
21% 100% Insufficient
30% 150% REOX-LOX
60% 300% REOX-HOX
100% 500% Excessive
To do this, a multicenter randomized double-blind study
was designed, with a cohort of 325 patients selected from
infants who required any ventilatory support maneuver during
Fig. 2 Third, 10th, 25th, 50th, 75th, 90th, and 97th SpO2 percentiles for resuscitation, during the first 10 minutes after birth, and
preterm infants at < 32 weeks of gestation with no medical intervention after whose gestational age were less than 30 weeks but greater
birth.
than or equal to 24 weeks.
Randomization was balanced in blocks of 10 patients,
From these data, the standard target saturations are defined: stratified into two gestational age groups: ≤ 26 weeks (24, 25
and 26) and > 26 weeks (27, 28 and 29).
Time from birth Target SpO2 Range Formally, the main objective of the study is "to reduce the
3 minutes 55-80% rate of intubation in the delivery room derived from the quick
5 minutes 75-90% establishment of normal diaphragmatic movement and
10 minutes 90-97% physiological breathing pattern using low concentrations of
supplemental oxygen following the same pattern as in
experimental models." [17]
VI. THE REOX CLINICAL TRIAL
VII. BRIEF DESCRIPTION OF THE PHASES OF CLINICAL
TRIAL PROTOCOL.
A. Context
A. Phases 1 and 2: Validation of the Comprehensive
A decade after the heated debate [14] about the safety and Monitoring System.
necessity of using pure oxygen for resuscitation of
asphyxiated newborns [15], it can be assumed as proven that a "A comprehensive monitoring system will be implemented
to register at all times the performed resuscitation maneuvers
4. and the patient's response to them. This system will consist of REFERENCES
a central computer with special software that collects real-time [1] Stiller, R., et al. - How well does reflectance pulse oximetry reflect
biomedical signals sent from various monitors and peripherals intrapartum fetal acidosis? - Am J Obstet Gynecol, 2002. 186(6).
connected to the patient from ventilatory support system. [2] Merrill, J. and R. Ballard - Avery's diseases of the newborn. 8 ed. 2005,
New York: Elsevier.
Among the peripheral monitoring systems is included a pulse [3] Kamlin, O., et al. - Oxygen saturation in healthy infants immediately
oximetry to monitor both SpO2 and HR, an oximeter that after birth. - J Pediatr, 2006. 148(5).
monitors the amount of supplemental oxygen administered at [4] Yis, U., et al. - Hyperoxic exposure leads to cell death in the
any time and a pressure transducer to measure the pressure developing brain. - Brain and development, 2008. 30.
[5] Vento, M., et al. - Room-air resuscitation causes less damage to heart
applied to the airway. The system also includes a digital and kidney than 100% oxygen. - Am J Resp Care, 2005. 172.
camcorder that will record the entire resuscitation process [6] Hilman, N., et al. - Brief, Large Tidal Volume Ventilation Initiates
allowing to check that everything in the system worked Lung Injury and a Systemic Response in Fetal Sheep. - Am J Respir
properly. During this phase preterm infants < 30 weeks Crit Care Med, 2007. 176.
[7] Vento, M., et al. - Resuscitation With Room Air Instead of 100%
gestation who follow the usual algorithm of CPR will be Oxygen Prevents Oxidative Stress in Moderately Asphyxiated Term
monitored throughout the process, so we can validate the Neonates. - Pediatrics, 2001. 107(4).
system and the different resuscitation teams will acquire [8] Wang, C., et al. - Resuscitation of preterm infants using room air or
specific skills in its management." 100% oxygen. - Pediatrics, 2008. 121.
[9] Dawson JA, Kamlin CO, Vento M, Wong C, Cole TJ, Donath SM,
Davis PG, Morley CJ. - Defining the reference range for oxygen
B. Phase 3 Clinical Trial.
saturation for infants after birth. - Pediatrics. 2010 Jun;125(6):e1340-7.
... "Once the ventilatory support system is started with the Epub 2010 May 3.
initial parameters, the FiO2 will be adjusted according to the http://pediatrics.aappublications.org/content/125/6/e1340.long
[10] Escrig, R., et al. - Achievement of targeted saturation values in
measurements, to achieve an SpO2 target of 75% at 5 minutes extremely low gestational age neonates resuscitated with low or high
after birth and 85% at 10 minutes." ... oxygen concentration: a prospective, randomized trial. - Pediatrics,
2008. 121.
C. Phase 4: Patient Monitoring and Data Analysis. [11] ILCOR, A.i.c.w. - Guidelines 2000 for Cardiopulmonary Resuscitation
"All patients included in the study will be monitored until and Emergency Cardiovascular Care: international consensus of
science. - Circulation, 2000. 102: p. 343-58.
the age of 24 months of corrected age. In addition to the [12] Buron, E. and J. Aguayo - Neonatal resuscitation. Neonatal RCP
routine monitoring of such patients, at 40 weeks group of Neonatology Spanish Society. - An Pediatr, 2006. 65: p. 470-7.
postconceptional age will be held a structured neurological [13] M. Iriondo, E. Szyld, M. Vento, E. Burón, E. Salguero, J. Aguayo, C.
examination and brain MRI. In addition, the Ruiz, D. Elorza y M. Thió, Grupo de reanimación neonatal de la
Sociedad Española de Neonatología. - Adaptación de las
neurodevelopment will be evaluated using the Bayley scale at recomendaciones internacionales sobre reanimación neonatal 2010:
24 months corrected age. During this phase of the study the comentarios. - An Pediatr (Barc). 2011;75(3):203.e1—203.e14
data collected from the recruited patients will be processed [14] Modesto V, Pantoja J. - Reanimación neonatal con oxígeno al 100%. -
and the necessary analysis of the result variables whose An Esp Pediatr 2000; 53: 279.
[15] Vento M. - ¿Cuánto oxígeno es suficiente para reanimar a un recién
process is complete will be carried out . An interim analysis of nacido asfíctico? - An Esp Pediatr 2000; 53: 210-212
the data will be made once collected at least half of the sample [16] Kondo M, Itoh S, Isobe K, Kondo M, Kunikata T, Imai T et al. -
to determine if there are clear results that can change the Chemiluminiscence because of the production of reactive oxygen
course of study." species in the lungs of born piglets during resuscitation periods after
asphyxiation load. - Ped Res 2000; 47: 524-527.
[17] Bookatz, B., et al. - Effect of suplemental oxygen on reinitation of
breathing after neonatal resucitation in rat pups. - Pediatr Res, 2007.
61(6).