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Efficacy of Non Invasive Biphasic Cuirass Ventilation (BCV) in Neonatal Piglets Comparison with Conventional Positive Pressure Ventilation - PowerPoint PPT Presentation
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Efficacy of Non Invasive Biphasic Cuirass Ventilation (BCV)
in Neonatal Piglets Comparison with Conventional
Positive Pressure Ventilation
F.G. Eyal, MD, I. Gur, MD, K.T. O'Donnell, BS and C.R. Hamm Jr. University of South Alabama, Mobile, Alabama, United States and Bikur Holim Hospital, Jerusalem, Israel .
We have nothing to Disclose
The need for prolonged IPPVdespite successful surfactant treatment
is a major risk factor for BPDCan
NEGATIVE PRESSURE VENTILATION
be a successful NON INVASIVE alternative mode of ventilation for newborns at risk for BPD
DÉJÀ VU ?DÉJÀ VU ?1970197019501950 PAST :
Effective ventilation of surfactant deficient lungs required levels of inspiratory pressure beyond the capacity of
negative pressure respirators incubator
PRESENT : Surfactant treatment restores normal lung compliance Continued prolonged ventilatory support relates to poor respiratory drive (apnea of prematurity ) BCV is a modified efficient form of negative pressure
ventilation successful in adult and children with respiratory failure due to neuromotor dysfunction
HAYEK RTX Respirator
Medivent, London
HAYEK RTX Respirator
Medivent, London
Purpose of this study:
investigate the efficiency of BCV in an neonatal animal model
Purpose of this study:
investigate the efficiency of BCV in an neonatal animal model
• Can Biphasic Cuirass ventilation successfully ventilated apneic newborn
• Does the cuirass positive pressure component used during expiration :– Enhanced its efficiency– Can this “mild” compression adversely affect FRC
in newborn who have a very compliant chest wall
• What is the optimal I:E ratio in relation to efficiency
• Can Biphasic Cuirass ventilation successfully ventilated apneic newborn
• Does the cuirass positive pressure component used during expiration :– Enhanced its efficiency– Can this “mild” compression adversely affect FRC
in newborn who have a very compliant chest wall
• What is the optimal I:E ratio in relation to efficiency
MethodsMethods
Newborn piglets : 4.7 ± .4 days (2.2 ± 0.1 kg) (n= 42)
Anesthetized & paralyzed
Mechanical Ventilation40 breaths /mn; VT :11 ± .5 ml/kg , Fi02 : .4
Newborn piglets : 4.7 ± .4 days (2.2 ± 0.1 kg) (n= 42)
Anesthetized & paralyzed
Mechanical Ventilation40 breaths /mn; VT :11 ± .5 ml/kg , Fi02 : .4
PaCO2 PaO2
Ventilatory Efficiency Index (VEI)VEI=3800*/(respiratory rate x [PIP – PEEP or NCIP-EECP] x PaCO2]
*: 3800 is a CO2 production constant :([ml x mm Hg]/[kg x min])
BCV associated to nasal CPAP could be an beneficial alternative to endotracheal IPPV in preterm infants who continue to require
mechanical ventilation after surfactant treatment
BCV associated to nasal CPAP could be an beneficial alternative to endotracheal IPPV in preterm infants who continue to require
mechanical ventilation after surfactant treatment
CONCLUSIONSCONCLUSIONSBiphasic Cuirass Ventilation
is an effective method of ventilation in neonatesPositive expiratory cuirass pressure enhanced its efficiency
(in terms of C02 elimination)
This enables the use of inspiratory pressure of low amplitude (a limiting factor in the past for its efficient use in neonates)
The decline in lung volume associated with expiratory positive cuirass pressure
is prevented by the concomitant use of CPAP and a cuirass I:E ratio of 2:1
PROBLEMSSKIN INTEGRITY
THERMOREGULATION
PROBLEMSSKIN INTEGRITY
THERMOREGULATION