Pediatric Infectious Obstructive Airway Diseases小儿感染性阻塞性气道疾病.pptxVIP

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Pediatric Infectious Obstructive Airway Diseases小儿感染性阻塞性气道疾病.pptx

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Pediatric Infectious Obstructive Airway Diseases小儿感染性阻塞性气道疾病

Neonatal Mechanical Ventilation Fred Hill, MA, RRT Early Mechanical Ventilation Primary forms CPAP Time-cycled, pressure-limited IMV Limitations Neonatal diseases not well understood Equipment was primitive Monitoring capabilities limited Similar treatment regardless of newborn condition Evolution of Neonatal Mechanical Ventilation 1970s Continuous monitors (TCM) Echocardiography New styles of ventilation Evolution of Neonatal Mechanical Ventilation 1980s Proliferation of new technologies Widespread clinical trials Development of disease specific strategies End of 1980s Pulse oximetry was a standard of care Testing of surfactant replacement therapy HFV established as alternative therapy ECMO was ultimate rescue therapy for term and near- term infants Evolution of Neonatal Mechanical Ventilation 1990s Surfactant therapy and antenatal corticosteroids Real time pulmonary graphic monitoring Many new ventilatory techniques Efficacy of inhaled NO demonstrated Better understanding of mechanisms of lung injury (BPD, CLD) Evolution of Neonatal Mechanical Ventilation Twenty-first Century No consensus on how to manage neonatal respiratory failure Need for a disease-specific approach Need for flexibility Respiratory Distress Syndrome Surfactant replacement therapy has had significant impact Still significant mortality morbidity CLD still is a problem Variance in management styles Limited clear evidence upon which to draw conclusions Where is the line for extrauterine viability? Meconium Aspiration Treatment controversial Varies depending upon the presence of PPHN Role of surfactant replacement is being explored Traditional suctioning of meconium stained newborns has been challenged Persistent Pulmonary Hypertension of the Newborn (PPHN) Aggressive hyperventilation and induced alkalosis Conservative ventilation Bronchopulmonary Dysplasia Now more often called CLD Definitions often not helpful Oxygen dependence at 28 days or 36 weeks post conception Does not account for episodic