PURPOSE: Early surfactant therapy with either gentle ventilation, high-frequency ventilation or aggressive weaning of mechanical ventilation are principles for the treatment of respiratory distress syndrome(RDS). We studied to determine the accessibility of noninvasive nasal continuous positive airway pressure(CPAP) rather than mechanical ventilation by invasive intubation after early surfactant therapy. METHODS: The study group consisted of 14 infants who were born and diagnosed with moderate respiratory distress syndrome and received early surfactant therapy with nasal CPAP of PEEP 5-6 cm H2O within two hours after birth in the Fatima neonatal intensive care unit for two years from January 1999 to August 2001. The control group consisted of 15 infants who were diagnosed with the disease and could be weaned from mechanical ventilator within five days after birth during the same period. RESULTS: The characteristics, the severity of clinical symptoms and laboratory findings in the two groups at birth showed no significant difference. Neither did the interim analysis of laboratory data in two groups. Of 14 infants in the study group who received nasal CPAP after early surfactant therapy, only two infants showed weaning failure with this therapy. In the response cases, duration of CPAP was five days and mean airway pressure was 5.4+/-0.5 cm H2O. Two had the complication of CPAP with abdominal distension. Final complications and outcomes in the two groups showed no signifcant difference(p>0.05). CONCLUSION: The clinical courses in the two groups showed no significant difference. Therefore, we suggest that early surfactant therapy with noninvasive nasal CPAP is a simple and safe method rather than aggressive weaning after invasive mechanical ventilation in moderate respiratory distress syndrome.
Continuous Positive Airway Pressure* ; High-Frequency Ventilation ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation ; Parturition ; Respiration, Artificial ; Ventilation ; Ventilators, Mechanical ; Weaning

BACKGROUND: Noninvasive ventilation has been used extensively for the treatment of patients with neuromuscular weakness or restrictive chest wall disorders complicated by hypoventilatory respiratory failure. Recently, noninvasive positive pressure ventilation has been used in patients with alveolar hypoventilation,chronic obstructive pulmonary disease(COPD),and adult respiratory distress syndrome. Sanders and Kern reported treatment of obstructive sleep apnea with a modification of the standard nasal CPAP device to deliver seperate inspiratory positive airway pressure(IPAP) and expiratory positive airway pressure(EPAP).Bi-level positive airway pressure (BiPAP) unlike nasal CPAP, the unit delivers a different pressure during inspiration from that during expiration The device is similar to the positive pressure ventilator or pressure support ventilation. METHOD AND PURPOSE: Bi-level positive airway pressure(BiPAP) system(Respironics, USA) was applied to seven patients with acute respiratory failure and three patients on conventional mechanical ventilation. RESULTS: 1) Two of three patients after extubation were successfully achieved weaning from conventional mechanical ventilation by the use of BiPAP ventilation with nasal mask. Five of seven patients with acute respiratory failure successfully recovered without use of conventional mechanical ventilation. 2) PaO2 lhour after BiPAP ventilation in acute respiratory failure patients significantly improved more than baseline values(p<0.01)). PaCO2 lhour after BiPAP ventilation in acute respiratory failure patients did not change significantly more than baseline values. CONCLUSION: Nasal mask BiPAP ventilation can be one of the possible alternatives of conventional mechanical ventilation in acute respiratory failure and supportive method for weaning from mechanical ventilation.
Humans ; Intermittent Positive-Pressure Ventilation* ; Masks ; Noninvasive Ventilation ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Sleep Apnea, Obstructive ; Thoracic Wall ; Ventilation ; Ventilators, Mechanical ; Weaning

PURPOSE: To compare respiratory and clinical outcomes between the currently used strategy of Intubation, Surfactant, Extubation (InSurE) and nasal continuous positive airway pressure (NCPAP) and the alternative strategy of InSurE and nasal intermittent positive pressure ventilation (NIPPV) for the initial treatment of respiratory distress syndrome (RDS) in preterm newborns < or =32 weeks. METHODS: Twenty-six comparable preterm infants with RDS were included in the study; 13 were randomized to NCPAP and 13 to NIPPV. In both groups, the InSurE procedure consisted of intubation, surfactant instillation and 2 h positive pressure ventilation followed by extubation, after which spontaneously breathing newborns were placed on NCPAP or NIPPV. RESULTS: There were no differences in demographic characteristics or cardiorespiratory status among preterm infants enrolled in the study. The reinutation rate was lower among the infants treated with NIPPV than among those on NCPAP (8% vs. 46%, P<0.05) and the rate of aminophylline use between 4 and 7 days of age of was lower in the NIPPV group compared to the NCPAP group (8% vs. 30%, P<0.05). In addition, "InSurE with NIPPV" significantly reduced the overall duration of endotracheal ventilation and shortened the time to first feed compared to "InSurE with NCPAP". CONCLUSION: "InSurE with NIPPV" displayed therapeutic benefits as the initial treatment of preterm RDS when compared with the currently used ventilator strategy, "InSurE with NCPAP" by preventing re-intubation and shortening the duration of endotracheal ventilation.
Aminophylline ; Continuous Positive Airway Pressure* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation* ; Intubation ; Pilot Projects* ; Positive-Pressure Respiration ; Prospective Studies* ; Respiration ; Ventilation ; Ventilators, Mechanical

BACKGROUND: Morbidity and mortality rates from acute respiratory failure remain noteworthy despite advances in conventional ventilatory techniques and improvements in supportive care. Repeated, the large tidal volume breaths during positive pressure mechanical ventilation lead to destruction of alveoli and pulmonary capillaries. Moreover, the overdistention of terminal lung units is considered as an important mechanism of ventilator induced lung injury. High frequency ventilation (HFV) is a technique involving a small tidal volume, and a higher than physiologic respiratory rate. Partial liquid ventilation (PLV), also known as perfluorocarbon-associated gas exchange, is a new technique for respiratory support. This study was designed to compare conventional mechanical ventilation (CMV) and high frequency jet ventilation (HFJV), in combination with PLV. METHODS: Twenty rabbits were anesthetized with xylazine, ketamine and vecuronium. We studied rabbits with lung injury induced by saline lavage. Animal were randomized into one of two treatment groups. Ventilator parameters included the following; CMV: FIO2 of 1.0, respiratory rate 20-30 breaths/min, I/E ratio 1 : 1; HFJV: respiratory rate 2 Hz, driving pressure 2psi. Animals were briefly disconnected from the ventilator and lungs were lavaged with warmed saline. This procedure was repeated until PaO2 < 100 mmHg. After one hour, we initiated the instillation of perfluorodecalin via an endotracheal tube. Baseline measurements were performed at 60 mins after the induction of anesthesia and repeated again at hour after the induction of lung injury, which included 30 mins of stabilization. After PFD instillation, data were recorded. RESULTS: All animals developed hypoxemia after the lung injury, but oxygenation improved significantly after perfluorodecalin instillation. The PLV-HFJV group showed a high pH and a low PaCO2. Mean arterial pressure, cardiac index and systemic vascular resistance was differed significantly. Although there were no qualitative histological differences between lungs ventilated with HFJV on CMV, the lower lobes of all PLV-treated animals were damaged less than the upper lobes, but without statical significance. CONCLUSIONS: PLV-HFJV produced a more efficient gas exchange than PLV-CMV. No significant difference was observed in the pulmonary pathologies of the groups.
Anesthesia ; Animals ; Anoxia ; Arterial Pressure ; Capillaries ; High-Frequency Jet Ventilation* ; High-Frequency Ventilation ; Hydrogen-Ion Concentration ; Ketamine ; Liquid Ventilation* ; Lung Injury* ; Lung* ; Mortality ; Oxygen ; Pathology ; Rabbits ; Respiration, Artificial ; Respiratory Insufficiency ; Respiratory Rate ; Therapeutic Irrigation ; Tidal Volume ; Vascular Resistance ; Vecuronium Bromide ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical ; Xylazine

High frequency ventilation has been used experimentally and clinically in a variety of situations. This report describes two cases in which high frequency jet ventilation was used to provide adequate ventilation during thoracic surgery. A solenoid valve controlled ventilator at rates of 100 breaths/min. with a double lumen tube provided adequate gas exchange for these patients with an open chest. The minimal lung movement during high frequency jet ventilation was found to provide excellent operating conditions without undue cardiovascular embarrassment. This case report demonstrates the use of high frequency jet ventilation in two adults undergoing operation ofr pulmonary lobectomy and biopay with segmental resection.
Adult ; High-Frequency Jet Ventilation ; High-Frequency Ventilation ; Humans ; Lung ; Thoracic Surgery* ; Thorax ; Ventilation* ; Ventilators, Mechanical

OBJECTIVE: The usage of mechanical ventilator has been an issue in advanced stage of most neuromuscular diseases. The patients experience hypoventilation symptoms and usually die from pulmonary complications at last. Besides traditional invasive mechanical ventilation, non-invasive intermittent positive pressure ventilation (NIPPV) has provided an alternative treatment option. We evaluated the effects of NIPPV. METHOD: We applied NIPPV method to the patients with advanced neuromuscular disease who were hospitalized due to ventilatory failure, who visit our outpatient clinic due to hypercapnic symptoms, or who showed hypercapnia on a routine follow-up. To evaluate ventilatory status, blood gas tensions were analyzed by the arterial blood gas analysis and/or pulse-oxymeter and capnometer. Overnight pulse-oxymeter monitorings were done whenever necessary. RESULTS: Thirty patients were managed with NIPPV successfully. In five cases, invasive IPPV with tracheostomy at admission was switched to NIPPV. Three patients who had been intubated to receive IPPV were transferred to NIPPV without being tracheostomized. CONCLUSION: NIPPV can be used safely and effectively as an alternative method of ventilatory support for the patients with advanced neuromuscular disease who show ventilatory failure. It would relieve symptoms and signs of hypoventilation and prevent the acute respiratory muscle decompensation, if applied before overt ventilatory failure.
Ambulatory Care Facilities ; Blood Gas Analysis ; Follow-Up Studies ; Humans ; Hypercapnia ; Hypoventilation ; Intermittent Positive-Pressure Ventilation ; Neuromuscular Diseases* ; Respiration, Artificial ; Respiratory Muscles ; Tracheostomy ; Ventilators, Mechanical*

Currently conventional modes of controlled mechanical ventilation, such as intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV), with high volumes and low rates are utilized for the rhythmic inflation of the lungs. Basically the functional characteristics of these systems have not changed since Bjork and Engstrom first reviewed them in 1955 (Bjork and Engstrom 1955; Sjostrand 1983). Impairment of cardiovascular function and increasing the incidence of barotrauma with high airway pressure were problems which have needed to be solved. Thus respiratory support using high rates and low tidal volumes of ventilation was given. High-frequency ventilation(HFV) is not totally new idea, prototypes of it are found in nature in humming birds, insects and newborn babies. Moreover, HFV was reported in 1915 by Handerson who said that an adequate gas exchange could take place with a tidal volume less than the anatomical deadspace. But since the introduction of HFV in 1967, the basic concept of respiratory physiology has changed (Sjostrand and Smith 1983). HFV has received much attention in the last 20 years, resulting in a considerable accumulation of information. Many experimental and clinical studies have detailed the potential advantages of HFV but indicate that much work needs to be done to define and clarify the clinical role of these techniques and suggest that the standardized, reliable equipment with safety systems be developed. The purpose of this review is not to offer definite information for further investigation, but simply to provide background information for a better understanding of the experimental and clinical results recently achieved by many other researchers. Limited foci are as follows: 1) Definition and classification of HFV. 2) Technical developments and considerations. 3) Physiologic aspects of HFV. 4) Clinical applications. 5) Comparative studies between IPPV and HFV. 6) Problems and looking ahead.
Comparative Study ; High-Frequency Jet Ventilation ; High-Frequency Ventilation*/classification ; Human ; Intermittent Positive-Pressure Ventilation

Currently conventional modes of controlled mechanical ventilation, such as intermittent positive pressure ventilation (IPPV) and continuous positive pressure ventilation (CPPV), with high volumes and low rates are utilized for the rhythmic inflation of the lungs. Basically the functional characteristics of these systems have not changed since Bjork and Engstrom first reviewed them in 1955 (Bjork and Engstrom 1955; Sjostrand 1983). Impairment of cardiovascular function and increasing the incidence of barotrauma with high airway pressure were problems which have needed to be solved. Thus respiratory support using high rates and low tidal volumes of ventilation was given. High-frequency ventilation(HFV) is not totally new idea, prototypes of it are found in nature in humming birds, insects and newborn babies. Moreover, HFV was reported in 1915 by Handerson who said that an adequate gas exchange could take place with a tidal volume less than the anatomical deadspace. But since the introduction of HFV in 1967, the basic concept of respiratory physiology has changed (Sjostrand and Smith 1983). HFV has received much attention in the last 20 years, resulting in a considerable accumulation of information. Many experimental and clinical studies have detailed the potential advantages of HFV but indicate that much work needs to be done to define and clarify the clinical role of these techniques and suggest that the standardized, reliable equipment with safety systems be developed. The purpose of this review is not to offer definite information for further investigation, but simply to provide background information for a better understanding of the experimental and clinical results recently achieved by many other researchers. Limited foci are as follows: 1) Definition and classification of HFV. 2) Technical developments and considerations. 3) Physiologic aspects of HFV. 4) Clinical applications. 5) Comparative studies between IPPV and HFV. 6) Problems and looking ahead.
Comparative Study ; High-Frequency Jet Ventilation ; High-Frequency Ventilation*/classification ; Human ; Intermittent Positive-Pressure Ventilation

BACKGROUND: The use of positive end expiratory pressure (PEEP) in patients with acute lung injury (ALI) improves arterial oxygenation by alleviating pulmonary shunting, helping the respiratory muscles to decrease the work of breathing, decreasing the rate of infiltrated and atelectatic tissues, and increasing functional residual capacity. In a rabbit model of saline lavage-induced ALI, we examined the effects of PEEP on gas exchange, hemodynamics, and oxygenation during high frequency jet ventilation (HFJV), and then compared these parameters with those during conventional mechanical ventilation (CMV). METHODS: Twelve rabbits underwent repeated saline lavage to create ALI. The animals were divided in 2 groups: 1) Group CMV (n = 6), and 2) Group HFJV (n = 6). In both groups, we applied 2 levels of PEEP (5 cmH2O and 10 cmH2O) and then measured the arterial blood gas, mixed venous blood gas, and hemodynamic parameters. RESULTS: With administration of PEEP of either 5 cmH2O or 10 cmH2O, the arterial oxygen content of both groups was increased, although without statistically significant differences between groups. On the contrary, the arterial carbon dioxide content was significantly decreased in the HFJV group, as compared with the CMV group, during the entire experiment. Furthermore, there was significant decreases in mean arterial pressures in both groups with a PEEP of 10 cmH2O. CONCLUSIONS: The application of PEEP in rabbits with ALI effectively improves oxygenation in either HFJV or CMV.
Acute Lung Injury ; Animals ; Arterial Pressure ; Carbon Dioxide ; Functional Residual Capacity ; Hemodynamics ; High-Frequency Jet Ventilation ; Humans ; Oxygen ; Positive-Pressure Respiration ; Rabbits ; Respiration, Artificial ; Respiratory Muscles ; Therapeutic Irrigation ; Work of Breathing

OBJECTIVE: To investigate the real condition of pulmonary rehabilitation for patients with advanced neuromuscular diseases (NMDs) on mechanical ventilation in Korea. METHOD: In order to estimate current state of pulmonary rehabilitative management, chart review and pulmonary function evaluation were conducted in a total of 267 NMD patients who had applied mechanical home ventilator in our center from March 2001 to December 2008. RESULTS: Total 267 patients were included: 95 with Duchenne muscular dystrophy, 69 with other types of myopathy, 83 with amyotrophic lateral sclerosis (ALS), 20 with spinal muscular atrophy. Among them, 18 who were previously intubated and 17 patients who had undergone tracheostomy were switched into volume-limited non-invasive ventilation (NIV). At the time of hospital discharge, 234 patients were applied NIV successfully. Twenty other patients who once used continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) ventilators inappropriately were switched into volume-limited NIV. However, 20 patients who had successfully applied NIV first underwent tracheostomy due to exacerbation of underlying disease. CONCLUSION: Adequate pulmonary management is the only promising method to prevent lethal complications, and to prolong life span of advanced NMD patients. We assume that more NMD patients can improve their quality of life and prolong their life through proper pulmonary rehabilitation including regular pulmonary function check-ups and ventilatory state monitoring as well as early NIV application.
Amyotrophic Lateral Sclerosis ; Continuous Positive Airway Pressure ; Humans ; Korea ; Muscular Atrophy, Spinal ; Muscular Diseases ; Muscular Dystrophy, Duchenne ; Neuromuscular Diseases ; Noninvasive Ventilation ; Quality of Life ; Respiration, Artificial ; Tracheostomy ; Ventilators, Mechanical