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Niu J, He Z, Guan L, Zhou L, Chen R. Non-invasive high-frequency oscillatory ventilation for carbon dioxide clearance in a hypercapnic lung model of chronic obstructive pulmonary disease and healthy subjects. Eur J Intern Med 2024; 119:136-138. [PMID: 37730518 DOI: 10.1016/j.ejim.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Jianyi Niu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, China
| | - Zhenfeng He
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, China
| | - Lili Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, China.
| | - Luqian Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, China
| | - Rongchang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, China; Respiratory Mechanics Laboratory, Guangzhou Institute of Respiratory Health, National Center for Respiratory Medicine, First Affiliated Hospital of Guangzhou Medical University, China; Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
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Rub DM, Sivieri EM, Abbasi S, Sieberlich W, Eichenwald EC. Comparison of nasal intermittent positive pressure ventilation and bubble CPAP with an in-line high-frequency interrupter in a premature infant lung model. Pediatr Pulmonol 2022; 57:2356-2362. [PMID: 35722805 DOI: 10.1002/ppul.26039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Noninvasive ventilation has become a staple in the care of premature infants. However, failure rates continue to be high in this population. Modifications to noninvasive support, such as nasal intermittent positive pressure ventilation (NIPPV), are used clinically to reduce such failure. Previous in vitro studies have shown improved CO2 clearance when superimposing high-frequency oscillations onto bubble continuous positive airway pressure (BCPAP). OBJECTIVE To compare the CO2 clearance of NIPPV to BCPAP with an in-line high-frequency interrupter (HFI) in a premature infant lung model. METHODS A premature infant lung model was connected to either a Dräger VN500 for delivery of NIPPV or a BCPAP device with superimposed high-frequency oscillations generated by an in-line HFI. Change in end-tidal CO2 (ETCO2 ) and mean airway pressure at the simulated trachea were measured and compared for both noninvasive modalities. RESULTS Superimposing HF oscillations onto BCPAP with an in-line HFI resulted in improved CO2 clearance relative to BCPAP alone for all tested oscillation frequencies at all CPAP levels (p < 0.001). NIPPV also resulted in improved CO2 clearance relative to nasal CPAP (NCPAP) alone (p < 0.001). Among the tested settings, BCPAP with an in-line HFI resulted in decreased ETCO2 relative to BCPAP ranging from -14% to -36%, while NIPPV resulted in decreased ETCO2 relative to NCPAP ranging from -2% to -12%. CONCLUSION Superimposing high-frequency oscillations onto BCPAP using a novel in-line HFI was found to be more effective at clearing CO2 than NIPPV in a premature infant lung model.
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Affiliation(s)
- David M Rub
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Emidio M Sivieri
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Soraya Abbasi
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - William Sieberlich
- CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Eric C Eichenwald
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
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Effect of Continuous Nutrition Management Intervention on Nutritional Status and Development of Premature Infants Based on Mobile Medical APP. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8586355. [PMID: 35979052 PMCID: PMC9377948 DOI: 10.1155/2022/8586355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
Objective To explore the effect of continuous nutrition management intervention based on mobile medical APP on the nutritional status and development of premature infants. Methods Eighty premature infants treated in our hospital from May 2019 to April 2021 were enrolled. The patients were randomly divided into the control group and research group. The control group received routine nursing, and the research group received continuous nutrition management intervention based on mobile medical APP. The Neonatal Behavioral Neurological Assessment (NBNA) score, pain score, height, weight, head circumference, intellectual development score, serum Prealbumin (PA), retinol-binding protein (RBP), and disease occurrence were elucidated. Results First of all, the NBNA scores of the two groups were compared. The behavioral ability, passive muscle tension, active muscle tension, original reflex, and general evaluation scores of the research group were significantly higher when compared to the control. Secondly, we compared the pain scores of the two groups, there was no significant difference between the two groups before nursing (P > 0.05), but the pain scores of the research group were lower compared to the control group during the period of blood collection, recovery, discharge, and 6 months after discharge (P < 0.05). Compared with the growth and development indexes of the two groups, there was no significant difference between the two groups before nursing (P > 0.05). After nursing, the GDS score of the two groups increased, and the GDS score of the research group was higher than that of the control group. The difference of data was statistically significant (P < 0.05). Compared with the motor scores of the two groups, there was no significant difference between the two groups before nursing (P > 0.05). After nursing, the motor scores of the two groups increased, and the scores of PDMS-2 and TIMP in the research group were higher than those in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in serum PA and RBP before nursing, but the serum PA and RBP in the two groups increased after nursing, and the PA and RBP in the research group were higher than those in the control group, and the difference was statistically significant (P < 0.05). Finally, we compared the incidence of diseases between the two groups. Before nursing, the incidence of infection, retinopathy, chronic lung injury and anemia in the research group was lower, when compared to the control, and the difference was statistically significant (P < 0.05). Conclusion The intervention strategy of continuous nutrition management based on mobile medical APP for premature infants can significantly strengthen their nutritional status after discharge, promote their growth and development, improve their nutritional status, reduce the incidence of diseases in premature infants, and then enhance their quality of life.
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Sivieri EM, Eichenwald EC, Abbasi S, Wolfson MR. A novel in-line high frequency interrupter for use with bubble CPAP: A feasibility study in a premature lamb model. J Neonatal Perinatal Med 2022; 15:257-263. [PMID: 35275565 DOI: 10.3233/npm-210899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent in vitro testing of high frequency (HF) oscillation applied to bubble continuous positive airway pressure (BCPAP) using a novel flow interrupter device (HFI) demonstrated significantly improved CO2 washout while not altering delivered mean airway pressure (MAP) in a premature infant lung model. This study's aim was to evaluate the safety and efficacy of the HFI paired with BCPAP in an animal model of prematurity prior to clinical testing. DESIGN/METHODS Twelve fetal lambs, 131-135 days gestation, weight 3.51±0.42 kg, were delivered by Cesarean section. The lambs were supported by mechanical ventilation and weaned to spontaneous breathing with BCPAP at 6 cmH2O. A combined CO2/airflow sensor measured end-tidal (EtCO2) and tidal volume (VT). Blood gases, heart rate (HR), arterial pressure (Part), minute ventilation (MV), MAP, ventilatory efficiency index (VEI), thoracoabdominal phase angle and labored breathing index (LBI) were recorded over a 10-minute baseline period followed by four randomized 10-minute intervals with HFI set to either 8, 10, 12 or 15 Hz. RESULTS EtCO2 decreased from baseline by 11.1±2.2SE%, 16.6±4.3SE%, 13.5±4.9SE%, and 19.5±4.5SE% at 8, 10, 12, and 15 Hz respectively (p < 0.001). Blood gases, SpO2, HR, Part, MAP, VT, MV, esophageal pressure, phase angle, and LBI underwent no significant change with HF. Respiratory rate decreased, and VEI increased, by 14.9±4.5SD% (p = 0.037) and 83±22SD% (p < 0.011) respectively, averaged over all frequencies. CONCLUSIONS We demonstrated the safety and efficacy of a novel BCPAP flow interrupter device. HF applied to the respiratory system resulted in significantly improved CO2 clearance and ventilation efficiency with no deleterious physiological effects in a pre-term lamb model.
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Affiliation(s)
- E M Sivieri
- Children's Hospital of Philadelphia, Newborn Care at Pennsylvania Hospital, Philadelphia, PA, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - E C Eichenwald
- Children's Hospital of Philadelphia, Newborn Care at Pennsylvania Hospital, Philadelphia, PA, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Abbasi
- Children's Hospital of Philadelphia, Newborn Care at Pennsylvania Hospital, Philadelphia, PA, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M R Wolfson
- Lewis Katz School of Medicine, Departments of Physiology, Pediatrics, and Thoracic Medicine and Surgery, Temple Lung Center, Center for Translational Medicine at Temple University, Philadelphia, PA, USA
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Conceptual model of low-cost improvised bubble continuous positive airway pressure device for adults and its potential use in the COVID-19 pandemic. PLoS Negl Trop Dis 2022; 16:e0010221. [PMID: 35239650 PMCID: PMC8893615 DOI: 10.1371/journal.pntd.0010221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Low-cost improvised continuous positive airway pressure (CPAP) device is safe and efficacious in neonatal respiratory distress. There is a great necessity for similar device in adults, and this has been especially made apparent by the recent Coronavirus Disease 2019 (COVID-19) pandemic, which is unmasking the deficiencies of healthcare system in several low-resource countries. We propose a simplified and inexpensive model of improvised CPAP in adults using locally available resources including aquarium air pumps and a novel pressure release mechanism. Although the safety and efficacy of improvised CPAP in adults are not established, the conceptual model we propose has the potential to serve as a lifesaving technology in many low-resource settings during this ongoing pandemic and thus calls for expedited research. An aquarium air pump, few plastic tubes, and a tight-fitting mask can be used to form an improvised continuous positive airway pressure (CPAP) device that could be lifesaving for many in low-resource countries. Although the device seems promising, further research is needed to establish its safety and efficacy.
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Delecaris AO, Averill SH, Krasinkiewicz J, Saunders JL, Ren CL. Pediatric pulmonology year in review 2020: Physiology. Pediatr Pulmonol 2021; 56:2444-2448. [PMID: 34043883 DOI: 10.1002/ppul.25504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Pulmonary physiology is a core element of pediatric pulmonology care and research. This article reviews some of the notable publications in physiology that were published in Pediatric Pulmonology in 2020.
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Affiliation(s)
- Angela O Delecaris
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Samantha H Averill
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan Krasinkiewicz
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica L Saunders
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Sivieri EM, Rub DM, Abbasi S, Eichenwald EC. Preserved pressure delivery during high-frequency oscillation of bubble CPAP in a premature infant lung model with both normal and abnormal lung mechanics. Pediatr Pulmonol 2021; 56:1136-1144. [PMID: 33497536 DOI: 10.1002/ppul.25267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bubble continuous positive airway pressure (BCPAP) generates pressure oscillations which are suggested to improve gas exchange through mechanisms similar to high frequency (HF) ventilation. In a previous in-vitro lung model with normal lung mechanics, significantly improved CO2 washout was demonstrated using an HF interrupter in the supply flow of a BCPAP system. The effect of HF with BCPAP on delivered airway pressure (Paw) has not been fully investigated in a lung model having abnormal pulmonary mechanics. OBJECTIVE To measure Paw in an infant lung model simulating normal and abnormal pulmonary compliance and resistance while connected to a BCPAP system with superimposed HF oscillations created using an in-line flow interrupter. DESIGN/METHODS A premature infant lung model with either: normal lung mechanics, compliance 1.0 ml/cm H2 O, airway resistance 56 cm H2 O/(L/s); or abnormal mechanics, compliance 0.5 ml/cm H2 O, airway resistance 136 cm H2 O/(L/s), was connected to BCPAP with HF at either 4, 6, 8, 10, or 12 Hz. Paw was measured at BCPAPs of 4, 6, and 8 cm H2 O and respiratory rates (RR) of 40, 60, and 80 breaths/min and 6.0 ml tidal volume. RESULTS Mean Paw averaged over all five frequencies showed no significant change from non-oscillated levels at all BCPAPs and RRs for both lung models. Paw amplitudes (peak-to-trough) during oscillation were significantly greater than the non-oscillated levels by an average of 1.7 ± 0.5 SD and 2.6 ± 0.5 SD cm H2 O (p < .001) for the normal and abnormal models, respectively. CONCLUSIONS HF oscillation of BCPAP using a flow interrupter did not alter mean delivered Paw compared to non-oscillated BCPAP for both normal and abnormal lung mechanics models. This simple modification to BCPAP may be a useful enhancement to this mode of non-invasive respiratory support.
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Affiliation(s)
- Emidio M Sivieri
- CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David M Rub
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Soraya Abbasi
- CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric C Eichenwald
- CHOP Newborn Care at Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.,Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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