The Experts below are selected from a list of 336 Experts worldwide ranked by ideXlab platform
Birgitta Janerot-sjöberg - One of the best experts on this subject based on the ideXlab platform.
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Beat-to-beat changes in stroke volume precede the general circulatory effects of mechanical ventilation: a case report
Critical Care, 2001Co-Authors: Nina Nelson, Birgitta Janerot-sjöbergAbstract:Background The haemodynamic as well as the ventilatory consequences of mechanical ventilation can be harmful in critically ill neonates. Newly developed ventilatory lung protective strategies are not always available immediately and in an acute situation the haemodynamic changes caused by mechanical ventilation can affect the oxygen delivery considerably. We report the case of a male neonate who was treated with conventional pressure-controlled mechanical ventilation because of respiratory distress and progressive respiratory acidosis resulting from meconium aspiration. Because of poor arterial oxygenation despite 100% inspired oxygen and increased ventilator settings, echocardiography was performed to exclude central haemodynamic reasons for low oxygen delivery. Method Doppler echocardiography was used for the measurement of stroke volume and cardiac output. Pulse oximetry and aortic blood pressure were monitored continuously. Results Echocardiography revealed no cardiac malformations or signs of Persistent Fetal Circulation. When inspiratory pressures and duration were increased, beat-to-beat variation in stroke volume preceded decay in cardiac output. Stroke volume variations and oxygen saturation values guided ventilator settings until extracorporal membrane oxygenation could be arranged for. After recovery and discharge 4 weeks later the boy is progressing normally. Conclusion Because oxygen delivery is dependent on both blood flow and arterial oxygen content, measurement of cardiac output as well as left heart oxygen saturation is a useful guide to optimizing oxygen delivery. This case report demonstrates how Doppler echocardiographic monitoring of beat-to-beat changes in stroke volume can be used to detect early negative haemodynamic effects of increased mechanical ventilation settings before cardiac output is affected.
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Primary research Beat-to-beat changes in stroke volume precede the general circulatory effects of mechanical ventilation: a case report
2000Co-Authors: Nina Nelson, Birgitta Janerot-sjöbergAbstract:Background: The haemodynamic as well as the ventilatory consequences of mechanical ventilation can be harmful in critically ill neonates. Newly developed ventilatory lung protective strategies are not always available immediately and in an acute situation the haemodynamic changes caused by mechanical ventilation can affect the oxygen delivery considerably. We report the case of a male neonate who was treated with conventional pressure-controlled mechanical ventilation because of respiratory distress and progressive respiratory acidosis resulting from meconium aspiration. Because of poor arterial oxygenation despite 100 % inspired oxygen and increased ventilator settings, echocardiography was performed to exclude central haemodynamic reasons for low oxygen delivery. Method: Doppler echocardiography was used for the measurement of stroke volume and cardiac output. Pulse oximetry and aortic blood pressure were monitored continuously. Results: Echocardiography revealed no cardiac malformations or signs of Persistent Fetal Circulation. When inspiratory pressures and duration were increased, beat-to-beat variation in stroke volume preceded decay in cardiac output. Stroke volume variations and oxygen saturation values guided ventilator settings until extracorporal membrane oxygenation could be arranged for. After recovery an
Vaughn A. Starnes - One of the best experts on this subject based on the ideXlab platform.
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surgical repair of transposition of the great arteries in neonates with Persistent pulmonary hypertension
The Annals of Thoracic Surgery, 1996Co-Authors: Anthony C Chang, Giovanni Battista Luciani, Vaughn A. StarnesAbstract:Background. Pulmonary hypertension due to Persistent Fetal Circulation is rarely associated with transposition of the great arteries and intact ventricular septum. Previous attempts at management of affected neonates using prostaglandin E 1 and balloon atrial septotomy followed by surgical repair have been largely unsuccessful. Methods. Between September 1992 and April 1995, 45 neonates underwent repair of transposition of the great arteries with the arterial switch operation. Two patients (4%) with transposition of the great arteries and intact ventricular septum presented with profound reversed differential desaturation and right-to-left shunting at the level of the ductus arteriosus after balloon atrial septotomy. A diagnosis of Persistent pulmonary hypertension was established and both neonates entered an experimental management protocol using inhaled nitric oxide and rapid arterial switch operation. Results. Preoperative hemodynamic stabilization was achieved in 1 patient using 40 parts per million of inhaled nitric oxide, whereas the other required in addition extracorporeal membrane oxygenation for severe biventricular dysfunction. Both underwent successful surgical repair 4 to 5 days after admission, but received postoperatively 1 week of inhaled nitric oxide therapy for Persistent pulmonary hypertension. Follow-up echocardiography at 3 months showed good biventricular function and normal geometry of the ventricular septum, suggesting low pulmonary artery pressure, in both. Conclusions. A management protocol using inhaled nitric oxide and extracorporeal membrane oxygenation followed by the arterial switch operation was successfully used in neonates with transposition of the great arteries, intact ventricular septum, and Persistent pulmonary hypertension. Wider use of preoperative and post-operative inhaled nitric oxide may improve the surgical outcome of this difficult subset of patients.
Girija G. Konduri - One of the best experts on this subject based on the ideXlab platform.
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new approaches for Persistent pulmonary hypertension of newborn
Clinics in Perinatology, 2004Co-Authors: Girija G. KonduriAbstract:The management of Persistent pulmonary hypertension of newborn (PPHN) has seen remarkable advances in the recent years that have led to significant decreases in mortality and morbidity from this condition [1–4]. PPHN occurs when the pulmonary vascular resistance (PVR) fails to decrease at birth. The elevated pulmonary artery pressure decreases pulmonary blood flow and leads to right-to-left shunting across the patent ductus arteriosus or the patent foramen ovale. Because of the presence of these Fetal shunts, this condition was also referred to in the past as Persistent Fetal Circulation. However, right-to-left shunting can occur without PPHN, as in congenital heart diseases with left heart hypoplasia or obstruction. PPHN is therefore a more appropriate term for noncardiac causes of cyanosis with elevated PVR in term and near-term infants. The incidence of PPHN is estimated to be around 0.2% of term infants [2], with higher incidence in pregnancies with no prenatal care and with the use of tobacco and illicit drugs [2]. Conditions associated with Persistent pulmonary hypertension of newborn PPHN can occur without associated parenchymal lung disease (idiopathic) or with a variety of lung diseases. PPHN occurs most commonly in association with meconium aspiration syndrome (50%), followed by idiopathic PPHN (20%), pneumonia/sepsis (20%), respiratory distress syndrome (5%), and other causes (asphyxia, maternal diabetes, polycythemia, etc) [2,4]. Alveolar-capillary dysplasia, a developmental defect in the proper alignment of alveoli and pulmonary vessels to form the air-blood barrier, is being increasingly recognized in lethal cases of PPHN [5]. Congenital diaphragmatic hernia (CDH) is also often associated with PPHN [6]. However, infants with CDH have severe underlying
Nina Nelson - One of the best experts on this subject based on the ideXlab platform.
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Beat-to-beat changes in stroke volume precede the general circulatory effects of mechanical ventilation: a case report
Critical Care, 2001Co-Authors: Nina Nelson, Birgitta Janerot-sjöbergAbstract:Background The haemodynamic as well as the ventilatory consequences of mechanical ventilation can be harmful in critically ill neonates. Newly developed ventilatory lung protective strategies are not always available immediately and in an acute situation the haemodynamic changes caused by mechanical ventilation can affect the oxygen delivery considerably. We report the case of a male neonate who was treated with conventional pressure-controlled mechanical ventilation because of respiratory distress and progressive respiratory acidosis resulting from meconium aspiration. Because of poor arterial oxygenation despite 100% inspired oxygen and increased ventilator settings, echocardiography was performed to exclude central haemodynamic reasons for low oxygen delivery. Method Doppler echocardiography was used for the measurement of stroke volume and cardiac output. Pulse oximetry and aortic blood pressure were monitored continuously. Results Echocardiography revealed no cardiac malformations or signs of Persistent Fetal Circulation. When inspiratory pressures and duration were increased, beat-to-beat variation in stroke volume preceded decay in cardiac output. Stroke volume variations and oxygen saturation values guided ventilator settings until extracorporal membrane oxygenation could be arranged for. After recovery and discharge 4 weeks later the boy is progressing normally. Conclusion Because oxygen delivery is dependent on both blood flow and arterial oxygen content, measurement of cardiac output as well as left heart oxygen saturation is a useful guide to optimizing oxygen delivery. This case report demonstrates how Doppler echocardiographic monitoring of beat-to-beat changes in stroke volume can be used to detect early negative haemodynamic effects of increased mechanical ventilation settings before cardiac output is affected.
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Primary research Beat-to-beat changes in stroke volume precede the general circulatory effects of mechanical ventilation: a case report
2000Co-Authors: Nina Nelson, Birgitta Janerot-sjöbergAbstract:Background: The haemodynamic as well as the ventilatory consequences of mechanical ventilation can be harmful in critically ill neonates. Newly developed ventilatory lung protective strategies are not always available immediately and in an acute situation the haemodynamic changes caused by mechanical ventilation can affect the oxygen delivery considerably. We report the case of a male neonate who was treated with conventional pressure-controlled mechanical ventilation because of respiratory distress and progressive respiratory acidosis resulting from meconium aspiration. Because of poor arterial oxygenation despite 100 % inspired oxygen and increased ventilator settings, echocardiography was performed to exclude central haemodynamic reasons for low oxygen delivery. Method: Doppler echocardiography was used for the measurement of stroke volume and cardiac output. Pulse oximetry and aortic blood pressure were monitored continuously. Results: Echocardiography revealed no cardiac malformations or signs of Persistent Fetal Circulation. When inspiratory pressures and duration were increased, beat-to-beat variation in stroke volume preceded decay in cardiac output. Stroke volume variations and oxygen saturation values guided ventilator settings until extracorporal membrane oxygenation could be arranged for. After recovery an
Giovanni Battista Luciani - One of the best experts on this subject based on the ideXlab platform.
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surgical repair of transposition of the great arteries in neonates with Persistent pulmonary hypertension
The Annals of Thoracic Surgery, 1996Co-Authors: Anthony C Chang, Giovanni Battista Luciani, Vaughn A. StarnesAbstract:Background. Pulmonary hypertension due to Persistent Fetal Circulation is rarely associated with transposition of the great arteries and intact ventricular septum. Previous attempts at management of affected neonates using prostaglandin E 1 and balloon atrial septotomy followed by surgical repair have been largely unsuccessful. Methods. Between September 1992 and April 1995, 45 neonates underwent repair of transposition of the great arteries with the arterial switch operation. Two patients (4%) with transposition of the great arteries and intact ventricular septum presented with profound reversed differential desaturation and right-to-left shunting at the level of the ductus arteriosus after balloon atrial septotomy. A diagnosis of Persistent pulmonary hypertension was established and both neonates entered an experimental management protocol using inhaled nitric oxide and rapid arterial switch operation. Results. Preoperative hemodynamic stabilization was achieved in 1 patient using 40 parts per million of inhaled nitric oxide, whereas the other required in addition extracorporeal membrane oxygenation for severe biventricular dysfunction. Both underwent successful surgical repair 4 to 5 days after admission, but received postoperatively 1 week of inhaled nitric oxide therapy for Persistent pulmonary hypertension. Follow-up echocardiography at 3 months showed good biventricular function and normal geometry of the ventricular septum, suggesting low pulmonary artery pressure, in both. Conclusions. A management protocol using inhaled nitric oxide and extracorporeal membrane oxygenation followed by the arterial switch operation was successfully used in neonates with transposition of the great arteries, intact ventricular septum, and Persistent pulmonary hypertension. Wider use of preoperative and post-operative inhaled nitric oxide may improve the surgical outcome of this difficult subset of patients.