Goldsmith’s Assisted Ventilation of the Neonate

An Evidence-Based Approach to Newborn Respiratory Care

7th Edition - December 24, 2021
Editors: Martin Keszler, Gautham Suresh, Jay P. Goldsmith
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 7 6 1 7 7 - 2
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 6 1 7 8 - 9

A must-have reference for the entire NICU, Goldsmith’s Assisted Ventilation of the Neonate, 7th Edition, is the only fully comprehensive, evidence-based guide to all aspects o… Read more

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A must-have reference for the entire NICU, Goldsmith’s Assisted Ventilation of the Neonate, 7th Edition, is the only fully comprehensive, evidence-based guide to all aspects of this fast-changing field. Easy to use and multidisciplinary in scope, this trusted reference provides authoritative guidance on contemporary management of neonatal respiratory diseases, with an emphasis on evidence-based pharmacologic and technologic advances that improve outcomes and quality of life in newborns. It’s an outstanding resource for neonatologists and NICU professionals to acquire new knowledge and techniques in this critical area of neonatal care.

Cover image
Title page
Table of Contents
Copyright
Contributors
Foreword
Preface
List of Tables
List of Illustrations
Section 1. History, Pulmonary Physiology, and General Considerations
1. Introduction and historical aspects
History of neonatal ventilation: Earliest reports
Sixteenth and seventeenth centuries
Eighteenth and nineteenth century
Twentieth century
Breakthroughs in ventilation
Recent advances and outcomes
Key references
References
2. Physiologic principles
Basic biochemistry of respiration: Oxygen and energy
Ontogeny recapitulates phylogeny: A brief overview of developmental anatomy
Mechanics
Gas transport
Oxygenation
Ventilation
Perfusion
Control of ventilation
Conclusion
Acknowledgments
Selected readings
References
3. Control of ventilation
Introduction
Pathogenesis of apnea of prematurity
Genesis of central, mixed, and obstructive apnea
Relationship between apnea, bradycardia, and desaturation
Cardiorespiratory events in intubated infants
Therapeutic approaches
Long-term consequences of neonatal apnea
Key references
References
4. Ethical issues in assisted ventilation of the neonate
Introduction
An ethical basis for decision making
Withdrawing and withholding assisted ventilation
Nonescalation and “heroic measures”
Moral distress
Coming to a consensus: When is withholding or withdrawal of assisted ventilation ethically permissible?
Chronic ventilation and tracheostomy
Conclusion
Key references
References
5. Evidence-based respiratory care
Background
The technical steps of evidence-based medicine
Cognitive skills for evidence-based practice
Translating evidence into practice
Summary
Suggested readings
References
6. Quality and safety in respiratory care
Quality and safety: Background
Assessing and monitoring the quality of care
Quality indicators for comparative performance measures
Quality indicators for improvement
Improving the quality of care
The improvement team
Collaboration
Aim: What are we trying to accomplish?
Measurement: How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
Plan–do–study–act cycles
Ensuring the success of quality improvement projects
Leadership and unit culture
Why is quality improvement important in neonatal respiratory care?
Examples of quality and safety improvement in neonatal respiratory care
Conclusion
Key references
References
7. Medical and legal aspects of respiratory care
Disclaimer
General legal principles
Supervision of others
Malpractice
Malpractice issues specific to neonatology and neonatal respiratory care
Respiratory failure/mechanical ventilation
Decreasing the risk of a malpractice lawsuit
The future of malpractice litigation
Conclusion
Key references
References
Section 2. Patient Evaluation and Monitoring
8. Physical examination
Historical aspects
Importance of the physical examination
Technique of the physical examination
Interpretation of the findings of physical examination
Physical examination findings in specific clinical situations
Conclusion
Key references
References
9. Imaging: Radiography, lung ultrasound, and other imaging modalities
Introduction
Radiation exposure
Imaging modalities
Invasive support devices
Common etiologies of respiratory distress in infants
Congenital and surgical causes of respiratory distress
Key references
References
10. Blood gases: Technical aspects and interpretation
Introduction
Blood gas physiology
Techniques for obtaining blood samples
Choice of monitoring methods
Blood gas analyzers
Clinical interpretation of blood gases
Components of blood gas testing that are measured directly
Components of blood gas testing that are not measured directly
Errors in blood gas measurements
Assessing the accuracy of a blood gas result
Final thoughts
Acknowledgment
Key references
References
11. Noninvasive monitoring of gas exchange
Noninvasive monitoring of oxygenation
Noninvasive assessment of partial pressure of carbon dioxide
Tissue oxygen saturation monitoring using near-infrared spectroscopy
Conclusion
Key references
References
12. Pulmonary function and graphics
Introduction
Technical aspects
Respiratory physiology and pathophysiology of respiratory diseases
Display of respiratory signals
Display of pulmonary graphics using loops
Pulmonary mechanics
End tidal CO2 curve
Role of pulmonary graphics in daily ventilator management—optimizing ventilator settings
Pitfalls of graphics monitoring—troubleshooting
Evidence for the use of respiratory function monitoring to improve neonatal outcome
Acknowledgments
Key references
References
13. Airway evaluation: Bronchoscopy, laryngoscopy, and tracheal aspirates
Introduction
Flexible nasopharyngolaryngoscopy in the neonate
Direct microlaryngoscopy and rigid bronchoscopy in the neonate
Fiberoptic flexible bronchoscopy
Bronchoalveolar lavage and tracheal aspirates
Summary
Suggested readings
References
Section 3. Delivery Room Stabilization, Oxygen Therapy, and Respiratory Support
14. Delivery room stabilization and respiratory support
Introduction
Physiology of transition, asphyxia, and resuscitation
Anticipation and preparation for resuscitation
Clinical assessment, apgar score, saturation, and heart rate monitoring
Intervention basics: Cord clamping, warmth, position, suction, stimulation
Oxygen
Ventilation
Pressure sources
Interfaces
Endotracheal intubation
Intubation equipment and procedure
Laryngeal mask airway
Monitoring
Chest compressions
Epinephrine
Volume expansion
Special cases
Ethics
Postresuscitation care
Key references
References
15. Exogenous surfactant therapy
History
Surfactant function, composition, and metabolism
Types of surfactant
Acute pulmonary and cardiac effects of surfactant therapy
Clinical trials of surfactant therapy
Methods of administration of surfactant
Choice of surfactant product
Adverse effects of surfactant therapy
Economic aspects of surfactant therapy
Factors affecting the response to surfactant therapy
Long-term outcomes after surfactant therapy
Exogenous surfactant therapy for conditions other than respiratory distress syndrome
Conclusion
Key references
References
16. Oxygen therapy
History of the use of oxygen in clinical medicine
Basic principles of oxygen physiology
Oxygen in the fetal-to-neonatal transition and postnatal adaptation
Oxygen saturation in preterm infants with positive pressure ventilation and air
Oxygen during neonatal care in the neonatal intensive care unit
Evolving oxygen needs in the first weeks of life and new metabolic indices
Going home on oxygen
Oxygen saturation recommendations
Key references
References
17. Respiratory gas conditioning
Physiology and pathophysiology
Standards on humidification of medical gases for use with artificial respiratory support modalities
Procedures and devices for respiratory gas conditioning
Estimation and measurement of the efficiency of respiratory gas conditioning device brands
Key references
References
18. Noninvasive respiratory support
Introduction
Continuous positive airway pressure
Nasal ventilation
High-frequency nasal ventilation
Nasal high flow
Conclusion
Acknowledgments
Key references
References
19. Overview of assisted ventilation
Introduction
Unique challenges in mechanical ventilation of newborn infants
Basic ventilator mode classification
Initiation of mechanical ventilation
Monitoring and documentation during mechanical ventilation
Ventilation protocols
Key references
References
20. Basic modes of synchronized ventilation
Introduction
Trigger technology
Patient-ventilator interactions with synchronized ventilation
Synchronized intermittent mandatory ventilation
Choice of assisted ventilation modes
Guidelines for clinical application
Conclusion
Key references
References
21. Principles of lung-protective ventilation
Introduction
Neonatal respiratory failure
Ventilator-induced lung injury
Lung-protective ventilation: Basic principles
Lung-protective ventilation: Conventional mechanical ventilation
Lung-protective ventilation: High-frequency ventilation
Lung-protective ventilation: Weaning and extubation
Implications for practice and research
Key references
References
22. Volume-targeted ventilation
Rationale for tidal volume-targeted ventilation
Volume-controlled versus volume-targeted ventilation
Neonatal tidal volume-targeted ventilation
Volume guarantee
Suggested clinical guidelines (see also Table 22.3)
Pressure-regulated volume control
Volume ventilation plus
Volume targeted ventilation/adaptive pressure ventilation
Targeted tidal volume
Importance of open lung strategy
Alarms/troubleshooting
Conclusion
Key references
References
23. Special techniques of respiratory support
Introduction
Automated control of inspired oxygen
Ventilation techniques that provide support proportional to patient effort
Ventilation techniques designed to maintain minute ventilation
Conclusion
Key references
References
24. High-frequency ventilation
Types of high-frequency ventilators
Evidence base for clinical applications of high-frequency ventilation
Lung protective strategies with HFV: Limiting pressure while optimizing volume
Clinical applications of high-frequency ventilation in specific diseases
Knowledge gaps and research directions
Summary
Key references
References
25. Mechanical ventilation: Disease-specific strategies
Introduction
Respiratory distress syndrome
Meconium aspiration syndrome
Lung hypoplasia disorders
Bronchopulmonary dysplasia
Conclusion
Key references
References
26. Weaning and extubation from mechanical ventilation
Background
Weaning from ventilatory support
Weaning from pressure-controlled ventilation
Weaning from high-frequency ventilation
General strategies to facilitate weaning
Assessment of extubation readiness
Postextubation management
Extubation failure
Summary
Suggested readings
References
27. Common devices used for mechanical ventilation
Introduction to ventilators
Understanding modes of ventilation
Universal intensive care ventilators used for neonatal ventilation
Specialized neonatal ventilators
Summary
Key references
References
28. Extracorporeal membrane oxygenation
Introduction
History of cardiopulmonary bypass
Development of membrane oxygenators
Physiology of extracorporeal circulation
Patient selection
Technique for beginning extracorporeal membrane oxygenation
Daily management
Weaning
Decannulation
Outcome
Key references
References
Section 4. Bedside Care, Nutritional and Pharmacologic Support
29. Respiratory care of the newborn
Introduction
Techniques to provide positive-pressure ventilation
Noninvasive ventilation and continuous positive airway pressure
Heated humidified high-flow nasal cannula
Monitoring during respiratory support
Humidification and warming during respiratory support
Airway clearance techniques
Administration of medications into the respiratory tract
Clinician-based ventilator and weaning protocols
Resuscitation and stabilization at delivery
Key readings
References
30. Nursing care
Introduction
Assessment of the neonate
Pain assessment
Respiratory care
General care of the neonate
Care of the family
Conclusion
Key references
References
31. Nutritional support
The importance of nutrition during critical stages of lung development
Nutritional requirements
Parenteral nutrition
Enteral nutrition
Special nutritional considerations for infants with established bronchopulmonary dysplasia
Key references
References
32. Pharmacologic therapies
Introduction
Steroids
Sedation and analgesia
Muscle relaxants
Bronchodilators and mucolytic agents
Diuretics
Respiratory stimulants
Summary
Key readings
References
33. Common hemodynamic problems in the neonate requiring respiratory support
Introduction
Normal transition
Hemodynamic problems in the neonate
Conclusion
Key references
References
Section 5. Treatment of Specific Conditions, Surgical Interventions and Other Considerations
34. Diagnosis and management of persistent pulmonary hypertension of the newborn
Introduction
Etiology
Clinical features
Hypoxemia in persistent pulmonary hypertension of the newborn
Echocardiography and hemodynamic assessment in persistent pulmonary hypertension of the newborn20
Asphyxia, hypothermia, and persistent pulmonary hypertension of the newborn
Surfactants in persistent pulmonary hypertension of the newborn
Inhaled nitric oxide
Sildenafil
Milrinone
Prostaglandin E1
Endothelin receptor antagonists
Management of systemic hypotension in persistent pulmonary hypertension of the newborn
Preterm infants with early pulmonary hypertension (preterm persistent pulmonary hypertension of the newborn)
Conclusion
Key references
References
35. Care of the infant with congenital diaphragmatic hernia
Introduction
Antenatal assessment of severity and fetal management
Initial treatment and procedures in the delivery room
Transport from delivery room to neonatal intensive care unit
Initial ventilation in congenital diaphragmatic hernia
Gentle ventilation in congenital diaphragmatic hernia
Supportive measures
Pulmonary vasodilator therapy
Extracorporeal membrane oxygenation
Surgical repair
Pulmonary and nutritional outcome
Discharge and follow-up
Conclusion
Acknowledgment
Key references
References
36. Management of the infant with bronchopulmonary dysplasia
Introduction
Epidemiology, pathophysiology, and diagnosis of bronchopulmonary dysplasia
Prevention of bronchopulmonary dysplasia
Clinical presentation and evaluation of infants with established bronchopulmonary dysplasia
Physiologic basis for respiratory support in infants with established bronchopulmonary dysplasia
Management of infants with established bronchopulmonary dysplasia
Adjunctive respiratory support therapies in infants with established bronchopulmonary dysplasia
Pulmonary outcomes in infants with bronchopulmonary dysplasia
Conclusion
Selected readings
References
37. Medical and surgical interventions for respiratory distress and airway management
Introduction
Medical management of the neonatal airway
Anatomic disadvantages of the neonatal airway
Medical management of neonates with common respiratory disorders requiring surgical intervention
Surgical management of the neonatal airway
The pediatric surgeon/otolaryngologist as diagnostician and therapist
The pediatric surgeon/otolaryngologist as consultant
Key references
References
38. Intraoperative management of the neonate
Transitional physiology and pulmonary hypertension
Pulmonary development and lung injury
Anatomic considerations
Location of operation
Operative management
Additional operative considerations
Conclusion
Key references
References
Section 6. Complications of Respiratory Support, Special Considerations, and Outcomes
39. Complications of respiratory support
Complications of respiratory support
Mechanical ventilation
Endotracheal intubation
Unplanned extubation
Ventilator-induced lung injury
Ventilator-associated pneumonia
Ventilator-associated events and ventilator-associated conditions
Noninvasive respiratory support
Suggested readings
References
40. Neonatal respiratory care in resource-limited countries
Introduction
Scope of the need
Limiting factors
Current status
Establishing respiratory care programs
Outcomes of neonatal ventilation
Projected growth in neonatal ventilation: A global perspective
Ethical dilemmas
Conclusion
Acknowledgment
Key references
References
41. Transport of the ventilated infant
Important role of the transport team
Regionalized care
Transport team composition
Transport education
Transport physiology
Stabilization
Clinical issues
Equipment
Future directions
Key references
References
42. Discharge and transition to home care
Factors to consider when determining readiness for discharge
Discharge team
Predischarge needs assessment
Home environment
Equipment and supplies
Personnel resources
Home nursing
Emergency planning
Postdischarge follow-up
Tracheostomy care
Changing tracheostomy tubes
Outpatient management of supplemental oxygen therapy
Indications for home oxygen therapy
Oxygen delivery systems for home oxygen therapy
Strategies for discontinuation of home oxygen therapy
Key references
References
43. Neurologic effects of respiratory support in the neonatal intensive care unit
Introduction
Cerebral blood flow in the neonate
Brain injury in the preterm infant
Influence of oxygen concentration and carbon dioxide on cerebral blood flow
Mode of ventilation and brain injury
Medications used to treat respiratory conditions
Summary
Key references
References
44. Pulmonary and neurodevelopmental outcomes following ventilation
Introduction
Incidence and definitions of bronchopulmonary dysplasia
Pulmonary outcomes
Health care utilization
Neurodevelopmental outcomes of preterm infants with bronchopulmonary dysplasia
Outcomes after neonatal hypoxic respiratory failure
Conclusion
Key references
References
45. Gaps in knowledge and future directions for research
Introduction
Development and application of new methods of generating knowledge
Respiratory care
Management of specific respiratory and nonrespiratory conditions requiring assisted ventilation
Ancillary support
Development of devices
Current research
Concluding comments
Selected readings
References
Appendices
Index

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Martin Keszler

Gautham Suresh

Jay P. Goldsmith