Seminars in perinatology
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Seminars in perinatology · Dec 2000
ReviewThe current status of neonatal extracorporeal membrane oxygenation.
Marked changes have occurred in the practice of neonatal extracorporeal membrane oxygenation (ECMO) since the first survivor in 1975. Coagulation management has been markedly refined, new catheters allow ECMO to be done either in a venoarterial or venovenous (VV) mode, depending on cardiac function in the infant. A new design of the VV catheter will allow this technique to be used in more infants in the future. ⋯ This brings forward the question about regional needs for ECMO Centers and how to assure that centers have enough patients to maintain their clinical competencies. The challenge for the future is where to place ECMO as a therapy. Should it remain a rescue therapy? Or should there now be a trial comparing ECMO to conventional therapies, with morbidity and cost of care as the outcome variables?
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Seminars in perinatology · Dec 2000
ReviewEnhancement of mechanical ventilation of neonates by computer technology.
Mechanical ventilation is often required in the extremely small preterm infant because of transient failure of the immature control of breathing system, chest wall instability, weakness of the respiratory pump, and chronic lung disease. To better address some of these issues, computer algorithms have been developed for continuous automated control of the arterial hemoglobin oxygen saturation (by changing the fraction of inspired oxygen), of the tidal volume (by varying peak inspiratory pressure), and of minute ventilation (by changing respirator rate). Feasibility studies have shown that closed-loop computer control of physiologic target variables may stabilize oxygenation, decrease the transpulmonary pressure cost of ventilation, and expedite weaning from mechanical ventilation. ⋯ With this mode, the clinician selects gains for elastic and/or resistive unloading to tailor the ventilator pressure contour to the specific derangement in pulmonary mechanics (restrictive and/or obstructive). Most of these newer ventilatory strategies are as yet unproven and require randomized, controlled clinical study. Similarly, although on-line pulmonary mechanics monitoring during mechanical ventilation has become available with the adent of computer technology, its clinical utility is still not well established.