Clinics in perinatology
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This article reviews the physiology of thermoregulation, hypothermia, and hyperthermia. The differential diagnosis of hypothermia and hyperthermia is discussed. The benefits of hypothermia following hypoxic-ischemic injury are discussed; however, both hypothermia and hyperthermia, in the extreme, are potentially harmful to the newborn. Recommendations for the prevention of these problems are discussed, as well as available treatments.
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One of the most important interfaces between medicine and law occurs in the courtroom. When medical issues are litigated, physicians have potential to make excellent witnesses. This article reviews the proper role, qualifications, and ethical requirements of expert witnesses, the law of professional negligence, and the regulation of unprofessional testimony. Expert witness reform is also briefly discussed.
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Clinics in perinatology · Mar 2007
ReviewContinuous positive airway pressure and noninvasive ventilation.
Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) hold much promise as means to protect the lungs of newborn infants who have respiratory distress from many causes. A wide variety of options are available to the clinician, including CPAP, bilevel CPAP, and both synchronized and unsynchronized noninvasive mechanical breaths. Limited data are available regarding the best ways to use CPAP and NIV in today's NICU environment. This article reviews current information on these modalities, including available options, possible risks, and unanswered questions.
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Real-time pulmonary graphics allow breath-to-breath assessment of pulmonary mechanics and patient-ventilator interaction. It allows the clinician to customize ventilator settings based on pathophysiology and patient response, and may enable detection of complications before they become clinically apparent. Graphics also provide objective information about the efficacy of pharmacologic agents and changes in patient status over time.
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Recognition that volume, not pressure, is the key factor in ventilator-induced lung injury and the association of hypocarbia with neonatal brain injury demonstrate the importance of better control delivered tidal volume. New microprocessor-based ventilator modalities combine advantages of pressure-limited ventilation with the ability to deliver a more consistent tidal volume. ⋯ More consistent tidal volume, fewer excessively large breaths, lower peak pressure, less hypocapnia, shorter duration of mechanical ventilation, and lower levels of inflammatory cytokines have been documented in short-term clinical trials. It remains to be seen if these short-term benefits ultimately lead to a reduced incidence of chronic lung disease.