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Guidelines for Ventilator Use Help Premature Infants Breathe Easier

Sun, 06/12/2011 - 8:33pm
Bio-Medicine.Org

BOSTON, June 13, 2011 /PRNewswire-USNewswire/ -- Guidelines that reduce the use of mechanical ventilation with premature infants in favor of a gentler form of respiratory support can profoundly affect those children's outcomes while reducing the cost of care, according to a team of researchers at Children's Hospital Boston.

The team, led by Bernadette Levesque, MD, of the Division of Newborn Medicine at Children's Hospital Boston and the Neonatal Intensive Care Unit (NICU) at St. Elizabeth's Medical Center in Boston, published their findings today online in Pediatrics. Children's operates the NICU at St. Elizabeth's as part of its efforts to promote community access to pediatric care.

Babies born prematurely are often placed promptly on a mechanical ventilator with a tube in the airway (intubation) and with supplemental oxygen to help their immature lungs breathe. The excess pressure placed on the infant's lungs can lead to ventilator-induced inflammation, scarring, and potentially bronchopulmonary dysplasia (BPD), a disabling chronic lung disease.

"While they are sometimes necessary, both supplemental oxygen and mechanical ventilation are essentially toxic to premature babies' lungs," said Levesque, who is also an instructor in pediatrics at Harvard Medical School. "These guidelines really represent five different interventions aimed at limiting those exposures."

The study centered on five care guidelines intended to encourage the use of a "bubble" continuous positive airway pressure (bCPAP) system, rather than mechanical ventilators, and limit exposure to supplemental oxygen. The bCPAP system delivers warmed, humidified oxygen in a way that inflates a premature infant's lungs more gently. The five guidelines – exclusive use of bCPAP, provision of bCPAP in the delivery room, strict intubation criteria, strict extubation criteria, and prolonged CPAP with avoidance of nasal cannula oxygen before 35 weeks of age – wer

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