Journal of perinatology : official journal of the California Perinatal Association
-
Recognition that volume, not pressure, is the key factor in ventilator-induced lung injury and awareness of the association of hypocarbia and brain injury foster the desire to better control delivered tidal volume. Recently, microprocessor-based modifications of pressure-limited, time-cycled ventilators were developed to 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 hypocarbia and lower levels of inflammatory cytokines have been documented. It remains to be seen if these short-term benefits will translate into shorter duration of ventilation or reduced incidence of chronic lung disease.
-
Successful management of neonatal shock is driven by the etiology and pathophysiology of the cardiovascular compromise. In the clinical practice, however, we only have a limited ability to recognize the etiology of the condition (hypovolemia, myocardial dysfunction or abnormal vasoregulation). ⋯ In addition, although management strategies aimed at improving systemic blood pressure may have been associated with a decrease in mortality in critically ill neonates, there are no prospective data on the effect of these management strategies on morbidity, especially on long-term neurodevelopmental outcome. This paper briefly reviews some of the more frequently encountered clinical presentations of neonatal shock and describes the developmentally regulated cardiovascular responses to the pathophysiology-driven management strategies used in these clinical presentations in the critically ill preterm and term neonate.