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Biomedical subjects

F L Mannino

Publications and source records attributed to F L Mannino.

At least 19 recordsLinked to original sources
PubMed1996

Randomized multicenter trial comparing synchronized and conventional intermittent mandatory ventilation in neonates.

OBJECTIVE: To compare synchronized intermittent mandatory ventilation (SIMV) and conventional intermittent mandatory ventilation (IMV) in neonates. STUDY DESIGN: Prospective, multicenter, randomized clinical trial. SETTING: Level III neonatal intensive care units at six university or children's hospitals. PATIENTS: Three hundred twenty-seven infants receiving conventional IMV for respiratory distress syndrome, pneumonia, or meconium aspiration pneumonitis were randomly assigned a 7.5 +/- 6 hours of age to either continue with IMV or change to SIMV. Infants assigned to each mode of ventilation had similar birth weight (BW), gestational age, and Apgar scores at birth, and similar oxygenation indexes at randomization. They received similar surfactant therapy and had similar incidence of sepsis, seizures, secondary pneumonia, and necrotizing enterocolitis. In the infants with BW less than 1000 gm, more infants receiving IMV had surgical ligation of their patent ductus arteriosus than did those receiving SIMV (27 vs. 7 %; p = 0.02). ANALYSIS: Data was analyzed overall for all infants and also separately within three BW groups: less than 1000 gm, 1000 to 2000 gm, and more than 2000 gm. The 1000 to 2000 gm BW group was further analyzed in subgroups weighing 1000 to 1499 gm and 1500 to 2000 gm. RESULTS: In all infants, at 1 hour after randomization, the infants receiving SIMV had a lower mean airway pressure than those receiving IMV (8.08 +/- 2.15 vs. 8.63 +/- 2.59; p<0.05), with similar fractions of inspired oxygen and oxygenation indexes. Infants whose BW was 1000 to 2000 gm at 0.5 hour required a lower fraction of inspired oxygen with SIMV than with IMV (0.52 +/- 0.20 vs. 0.62 +/- 0.27; p<0.05) and had better oxygenation at 1 hour, as shown by lower oxygenation indexes with SIMV than with IMV (6.14 +/- 4.17 vs. 9.42 +/- 8.41; p = 0.01). Infants whose BW was 1000 to 2000 gm received a lower number of unit doses of sedative/analgesic drugs per infant during the first 4 days of SIMV than did infants receiving IMV (3.8 +/- 3.4 vs 6.3 +/- 5.5 unit doses; p = 0.02). Infants whose BW was more than 2000 gm had a shorter duration of mechanical ventilation with SIMV than with IMV (median, 72 vs 93 hours; p = 0.02). Three of the forty-six infants receiving IMV but none of the 47 infants receiving SIMV required extracorporeal membrane oxygenation. In the infants with BW less than 1000 gm, fewer infants treated with SIMV required supplemental oxygen at 36 weeks of postconceptional age than did those treated with IMV (47 vs 72%; p<0.05). In 83 infants whose lungs were mechanically ventilated for 14 days or longer, all with BW less than 2000 gm, those treated with SIMV regained their BW earlier than those treated with IMV (median, 21.5 vs 29 days; p<0.01). There were no differences in the rates of death, intraventricular hemorrhage (grades III and IV), air leak, need for pharmacologic paralysis, or need for supplemental oxygen at 28 days. CONCLUSIONS: We found that SIMV was at least as efficacious as conventional IMV, and may have improved certain outcomes in BW-specific groups.

Female↗
PubMed1996

A novel strategy to limit blood donor exposure and blood waste in multiply transfused premature infants.

UNLABELLED: Small, premature infants require frequent small-volume transfusions. Traditional methods of transfusion expose these infants to multiple blood donors. It has recently been demonstrated that multiple donor exposures can be safely prevented in these infants by the assignment of fresh units to them and by the use of a sterile connecting device to remove blood for transfusion, as needed until the expiration of the unit. However, the program resulted in the wasting of approximately 60 percent of the blood in each unit. STUDY DESIGN AND METHODS: To minimize blood waste without compromising the goal of limiting donor exposure, a model designed to predict each infant's transfusion requirements was investigated. The model assigned infants predicted to have high transfusion requirements to receive blood from a unit dedicated to their individual use. All other infants were assigned to receive blood from a unit that could be shared among as many as four similar infants. Infant donor exposure and blood unit wastage after institution of the infant assignment model were compared with the same measurements obtained before the use of the model, during which time infants were assigned to dedicated units at the discretion of the physician. RESULTS: The numbers of transfusions per infant (3.5 +/- 2.3) and of donor exposures per infant (1.5 +/- 0.7) under the assignment model were unaltered from those in controls (4.1 +/- 2.9 transfusions and 1.6 +/- 0.8 donor exposures); however, there was significantly less blood wastage in the group assigned to shared units (32 +/- 28%) than in the group assigned to dedicated units (62 +/- 17%; p < 0.05) or than was seen in an earlier study (60 +/- 23% wasted; p < 0.05). CONCLUSION: Improved management of blood resources can be achieved within the context of a transfusion program designed to safely limit donor exposure in infants who require frequent transfusion.

Birth Weight↗
PubMed1995

Improved oxygenation during synchronized intermittent mandatory ventilation in neonates with respiratory distress syndrome: a randomized, crossover study.

In a randomized, crossover study, we compared arterial partial pressure of oxygen and of carbon dioxide between consecutive periods of conventional and synchronized intermittent mandatory ventilation (SIMV). We studied spontaneously breathing infants with an endotracheal tube in place. The infants were < 12 hours of age, had a diagnosis of respiratory distress syndrome, and had an arterial/alveolar oxygen ratio of < 0.25. The infants had a mean birth weight of 1077 gm and gestational age of 28 weeks. The mean rate of asynchrony on intermittent mandatory ventilation (IMV) was 52% (range, 36% to 76%), and on SIMV was < 1%. Infants were randomly assigned to IMV or SIMV as their initial ventilator mode and underwent ventilation for four 15-minute periods, and crossed over to the alternate mode after each period. Ventilator settings and the fraction of inspired oxygen were not changed between modes. At the end of each period, arterial blood gas measurements were obtained; 26 paired comparisons were made between modes. The mean arterial partial pressure of oxygen was significantly higher during SIMV than during IMV (mean, 61.5 vs 53.3 mmHg; p < 0.01). The mean arterial partial pressure of carbon dioxide was slightly lower during SIMV than during IMV (mean, 42.7 vs 41.3 mm Hg; p < 0.05). The improvement in oxygenation demonstrated with SIMV may allow a reduction in ventilator pressure or oxygen exposure in this group of infants, who are at risk of having complications of ventilation.

Carbon Dioxide↗
PubMed1994

Prospective, randomized trial of the safety and efficacy of a limited donor exposure transfusion program for premature neonates.

We investigated the safety and efficacy of using a single unit of packed red blood cells until its expiration date (35 days) to meet the transfusion needs of infants weighting < 1.5 kg. Unit concentration of potassium and infants' hematocrit value, K+ level, pH, and base excess were measured before and after transfusion. Compared with control infants, study infants had similar transfusion needs, but received blood from significantly fewer donors. The age of the blood received by study infants was significantly older and had a higher plasma K+ level. However, the change in infants' serum K+ levels before and after a transfusion was not significantly different in the two groups, and no adverse effects from transfusion of older blood were observed. We conclude that a protocol that allows use of an assigned unit of packed red blood cells preserved with citrate-phosphate-dextrose-adenine anticoagulant until its expiration date is safe, minimizes donor exposures, and meets the transfusion needs of low birth weight neonates.

Blood Donors↗
PubMed1994

Increased and more consistent tidal volumes during synchronized intermittent mandatory ventilation in newborn infants.

We compared expiratory tidal and minute ventilation during conventional and synchronized intermittent mandatory ventilation (IMV and SIMV) in 30 infants with respiratory failure. Identical ventilator settings were used during each mode in each infant. Tidal volumes of ventilator breaths were smaller during IMV than during SIMV (6.2 +/- 1.8 versus 7.4 +/- 1.9 ml/kg; p < 0.01). The coefficient of variation of tidal volumes was higher during IMV than SIMV for both ventilator (25 +/- 12% versus 15 +/- 8%) and spontaneous breaths (39 +/- 15% versus 24 +/- 10%, p < 0.001). Minute ventilation, however, was the same during both modes. During IMV, one infant breathed synchronously and two were phase-locked in asynchrony with the ventilator. The infants with a mixed interaction on IMV (27 of 30) had tidal volumes that depended on the phase of spontaneous breathing at the time of onset of each ventilator breath. Tidal volumes of IMV breaths that began during the first half of spontaneous expiration had the smallest tidal volumes (5.4 +/- 1.8 ml/kg, p < 0.01), followed by those that began during the last half of inspiration (6.4 +/- 1.8 ml/kg, p < 0.01). Thus, the synchrony produced by SIMV allowed the ventilator to deliver larger and more consistent tidal volumes than during IMV.

Humans↗
PubMed1993

Response time and reliability of three neonatal patient-triggered ventilators.

We studied the response time (RT) and reliability of three neonatal patient-triggered ventilator (PTV) systems: the Draeger Babylog 8000, the Bear Cub enhancement module (CEM), and the Infrasonics Star Sync. In 10 adult rabbits, airway flow and pressure recordings showed the RT of the Star Sync to be shorter than that of the Bear CEM (53 +/- 13 versus 65 +/- 15 ms, p < 0.05), and both were shorter than that of the Babylog (95 +/- 24 ms, p < 0.01) by ANOVA. The RT of the Bear CEM and the Babylog increased significantly at decreased trigger sensitivity settings. All ventilators triggered successfully on assist-control (A/C). However, the Babylog had a higher rate of asynchrony on SIMV (30 +/- 25%) than the Bear CEM (1.1 +/- 0.3%) and the Star Sync (1.2 +/- 0.4%), p < 0.01. In 10 infants with respiratory failure, recordings of airway flow and pressure were made at ventilator inspiratory time (Ti) settings of 0.3, 0.4, and 0.5 s on assist-control and on SIMV at rates of 15, 30, 45, and 60 breaths/min. The Star Sync and Bear CEM triggered successfully on A/C (100%) and had low rates of asynchrony on SIMV (1 to 3%). The Babylog had a lower success rate on A/C (70 +/- 12%) and a higher rate of asynchrony on SIMV (29 +/- 30%) than the other two ventilators; p < 0.01. The lower reliability of the Babylog was due to its variable refractory period (0.2 to 0.5 s, to equal the set Ti).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Intrauterine death in multiple gestation.

Intrauterine death of one fetus in a multiple gestation is associated with significant morbidity and mortality in the surviving infant. This study is a retrospective review of 38 twin and 3 triplet gestations involving the intrauterine death of at least one fetus. The obstetrical history, placental pathology, autopsy findings, and neonatal history of the surviving infant are reviewed. Three cases involved the recent stillbirth of both twins, the remaining cases involved a surviving infant. In one case, neonatal death of a surviving twin occurred on day 19. In two sets of triplets, two stillbirths occurred, in the third case two infants were liveborn. The incidence of preterm delivery was 34%, which decreased to 18% if fetal cotwin death had occurred before 20 weeks gestation. Cesarean section was the method of delivery in 16 cases. There was an excess of velamentous cord insertions, which was most pronounced in the stillborn twin. Monochorionic placentation was found in 72%, also an excess. Neurological damage was known to have occurred in 19 of the 39 surviving infants. Fifteen of these 19 (79%) were associated with monochorionic placentation. The neurologically damaged twin infants, when compared to the normal infants, had the cotwin die later in gestation (31 vs 16.5 weeks), had a shorter duration between the death of the cotwin and delivery (2.5 vs 21 weeks), and delivered earlier in gestation (36.5 vs 39.5 weeks). The probable cause of neurological damage, in our opinion, was either exsanguination into the dead twin fetus, or disseminated intravascular coagulation which occurred in at least 13 cases. The incidence of antepartum death in a multiple gestation, and the potential for neurological damage is probably higher than previously thought. A review of the literature is presented and the clinical implications of this phenomenon are discussed.

Brain Damage, Chronic↗
PubMed1989

One-lung high-frequency ventilation in the management of an acquired neonatal pulmonary cyst.

Pulmonary cystic lesions presenting in the neonatal period can be congenital in origin, such as cystic adenomatoid malformation and congenital lobar emphysema, or they can be acquired. With recent advances in the support of premature infants with respiratory distress syndrome (RDS), acquired cystic lesions such as pulmonary interstitial emphysema (PIE), lobar emphysema, and parenchymal cysts have become more common. Several treatments have been proposed for these acquired lesions. We report what we believe to be the first case in which unilateral high-frequency ventilation (HFV) combined with low-rate intermittent mandatory ventilation (IMV) has been used to successfully manage an acquired lung cyst in a newborn.

Cysts↗
PubMed1989

[Spontaneous intestinal perforation in newborn infants. A form of necrotizing enterocolitis].

The present study comprised twelve premature infants with "spontaneous" gastrointestinal perforations studied retrospectively during a period of three years. This problem was found to be more frequent in extremely premature babies affected with respiratory distress syndrome and patent ductus arteriosus and accompanied with very high mortality. A clinical-pathological correlation was done with the intestinal biopsy or postmortem studies and according to these findings, it is suggested that "spontaneous" intestinal perforations probably represent a form of necrotizing enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1988

High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates: 3 years of experience.

A heterogeneous group of 45 neonates with severe pulmonary disease and inadequate gas exchange on conventional intermittent mandatory ventilation (IMV) was treated with a high-frequency oscillator combined with an IMV (HFO-IMV) system (Emerson Airway Vibrator connected to a BABYBird 1 ventilator). The mean gestational age was 33 weeks (25.5-43) and mean birth weight 2.02 kg (0.66-4.24). Primary diagnoses included respiratory distress syndrome (RDS; 23), pneumonia (12), persistent fetal circulation (PFC; 6), diaphragmatic hernia/hypoplastic lungs (4). The IMV rate was reduced from 78 to 29 BPM (P less than or equal to 0.0005), while maintaining lower partial pressure of carbon dioxide (PaCO2) (P less than 0.005) and higher partial pressure of oxygen (PaO2) (P less than or equal to 0.0025). Active air leaks were present in 20 infants and these infants responded most favourably to HFO-IMV. HFO-IMV failed to improve ventilation in neonates with diaphragmatic hernia/hypoplastic lungs. Complications during HFO-IMV were increased pulmonary secretions (11), worsening or recurrence of pre-existing air leaks (11), or occurrence of new air leaks (10). In 4 patients death was related to major air leak complications. Twenty-four infants died, 18 of them of a respiratory cause. Twenty-one infants finally survived. We assembled a well-tolerated system to provide HFO-IMV and to successfully ventilate neonates with severe respiratory disease, who failed to respond to conventional IMV. Initiation of HFO-IMV earlier in the course of the disease in this type of infant may improve survival.

Female↗
PubMed1987

Effects of infant ventilator design on spontaneous breathing.

Study of the mechanical work of spontaneous breaths taken by eight infants attached to infant ventilators. Work was estimated from the volume displacement and pressure fluctuations of breathing during steady state mechanical ventilator conditions (i.e., stable peak or PEEP pressures). A broad difference existed between manufacturers of infant ventilators; a dramatic reduction was seen in work when attached to a demand as compared to a continuous flow device. Additionally, some change in work occurred, depending on the phase of the IMV cycle in which spontaneous breath was taken. Dynamic testing of ventilators can reveal differences in function.

Equipment Design↗
PubMed1986

A system for high-frequency oscillatory ventilation and intermittent mandatory ventilation in neonates.

We combined high-frequency oscillatory ventilation and intermittent mandatory ventilation, using a system composed of an Emerson airway vibrator, a Babybird 1 ventilator, and rate/pressure monitors. The Emerson device, a modified air compressor with rate controller, oscillated a small volume of gas at the airway. This device was coupled to the bird unit through a circuit of our design. Humidified fresh gas and pressure-relief valves were provided by the bird ventilator, and mean airway pressure was adjusted by its expiratory-limb venturi device or by the end-expiratory pressure control. The volume of gas delivered by the oscillator to various sites was measured with a plethysmograph tuned to high frequencies. At frequencies of 20 to 30 Hz, a 27-ml volume from the oscillator decreased to between 7 and 14 ml at the proximal airway, and to between 0.1 and 2.3 ml at the distal tip of the endotracheal tube. The magnitude of this decrease depended on the size of the endotracheal tube, the circuit resistance of the ventilator, oscillation frequency, and the position of the oscillator's expansion-chamber valve. We have used this system for over 3 yr to ventilate sick neonates safely and effectively.

Equipment Design↗
PubMed1985

Moisture-conserving efficiency of condenser humidifiers.

The moisture-conserving efficiency of commercially available condenser humidifiers (small, disposable, airway humidifiers) was studied. A comprehensive comparison of all currently available condenser humidifiers utilising a laboratory system which simulated a breathing, intubated patient in temperature, humidity, dead space, and respiratory pattern characteristics was undertaken. The percentage of moisture conserved, or efficiency, of the humidifiers was calculated gravimetrically from the water loss of the testing system with and without the condenser humidifiers. The Portex Humid-Vent and Trach-Vent, Siemens Servo 150 and the Terumo Brethaia were evaluated. The data revealed an inverse correlation between efficiency and tidal volume. The most efficient were the Portex Humid-Vent at low tidal volumes and Siemens Servo 150 at the mid and high tidal volumes. To achieve a minimum inspired water content of 33 mg H2O/litre gas, a 79% condenser humidifier efficiency is necessary. None of these units met this requirement; however, they may be appropriate for limited clinical application.

Anesthesia, Inhalation↗
PubMed1984

Combined high-frequency oscillatory ventilation and intermittent mandatory ventilation in critically ill neonates.

Combined high-frequency oscillatory ventilation (HFOV) and intermittent mandatory ventilation (IMV) was used in 12 neonates with inadequate gas exchange with conventional IMV. Diagnoses included diaphragmatic hernia with hypoplastic lungs, pneumonia, persistent fetal circulation, and severe respiratory distress syndrome. In most patients there was severe air leak. Within 10 hours of beginning HFOV-IMV the mean arterial PCO2 fell from 60 +/- 5 (means +/- SEM) to 38 +/- 2 mm Hg (P less than 0.01) and the mean IMV rate was reduced from 96 +/- 8 to 17 +/- 4 breaths per minute (P less than 0.001). The mean arterial-alveolar oxygen tension ratio rose from 0.05 +/- 0.01 to 0.09 +/- 0.01 (P less than 0.005). Mean airway pressure in the trachea was reduced from 16 +/- 2 to 10 +/- 3 cm H2O (P less than 0.05). Four patients died, three of whom had diaphragmatic hernias with hypoplastic lungs. Five of the eight survivors had mild bronchopulmonary dysplasia requiring supplemental oxygen. These studies demonstrate that in some neonates with respiratory failure who fail to respond to conventional IMV, combined HFOV-IMV can be successful.

Bronchopulmonary Dysplasia↗