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Seminars in Perinatology Oct 2022Delivery room resuscitation of neonates is performed according to evidence-based neonatal resuscitation guidelines. Neonatal resuscitation guidelines focus on the... (Review)
Review
Delivery room resuscitation of neonates is performed according to evidence-based neonatal resuscitation guidelines. Neonatal resuscitation guidelines focus on the resuscitation of newborns suffering from perinatal asphyxia. Special considerations are needed when resuscitating newborns in locations other than the delivery room and for newborns with congenital anomalies. In this review, we examine the resuscitation of newborns at home and in the emergency department and highlight special considerations for resuscitating newborns with specific congenital anomalies. In addition, we explore the resuscitation of neonates in the neonatal intensive care unit and discuss the potential use of pediatric advanced life support guidelines. Finally, we highlight the importance of simulation to prepare teams for neonatal resuscitations. This review aims to prepare healthcare professionals in all disciplines caring for neonates at risk for requiring resuscitation under special circumstances.
Topics: Asphyxia Neonatorum; Child; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Pregnancy; Resuscitation
PubMed: 35738945
DOI: 10.1016/j.semperi.2022.151626 -
Chirurgia (Bucharest, Romania : 1990) 2017Damage control surgery is a combination of temporizing surgical interventions to arrest hemorrhage and control infectious source, with goal directed resuscitation to... (Review)
Review
Damage control surgery is a combination of temporizing surgical interventions to arrest hemorrhage and control infectious source, with goal directed resuscitation to restore normal physiology. The convention of damage control surgery largely arose following the discovery of the lethal triad of hypothermia, acidosis, and coagulopathy, with the goal of Damage Control Surgery (DCS) is to avoid the initiation of this "bloody vicious cycle" or to reverse its progression. While hypothermia and acidosis are generally corrected with resuscitation, coagulopathy remains a challenging aspect of DCS, and is exacerbated by excessive crystalloid administration. This chapter focuses on resuscitative principles in the four settings of trauma care: the prehospital setting, emergency department, operating room, and intensive care unit including historical perspectives, resuscitative methods, controversies, and future directions. Each setting provides unique challenges with specific goals of care.
Topics: Acidosis; Blood Coagulation Disorders; Hemorrhage; Humans; Hypothermia; Practice Guidelines as Topic; Resuscitation; Shock, Hemorrhagic
PubMed: 29088551
DOI: 10.21614/chirurgia.112.5.514 -
Seminars in Perinatology Dec 2019Immediately after birth through spontaneous breaths, infants' clear lung liquid replacing it with air, and gradually establishing a functional residual capacity to... (Review)
Review
Immediately after birth through spontaneous breaths, infants' clear lung liquid replacing it with air, and gradually establishing a functional residual capacity to achieve gas exchange. Most infants start breathing independently after birth and ~3% of infants who require positive pressure ventilation. When newborns fail to start breathing the current neonatal resuscitation guidelines recommend initiatingpositive pressure ventilationusing a face mask and a ventilation device. Adequate ventilation is the cornerstone of successful neonatal resuscitation; therefore, it is mandatory that anybody involved in neonatal resuscitation is trained in mask ventilation techniques. One of the main problems with mask ventilation is that it is very subjective with direct feedback lacking and not uncommonly, the resuscitator does not realise that their technique is unsatisfactory. Many studies have shown that monitoring tidal volume and leak around the mask or endotracheal tube enables the resuscitator to identify the problem and adjust their technique to reduce the leak and deliver and appropriate tidal volume. This chapter discusses the currently available monitoring devices used during stabilization/resuscitation in the delivery room.
Topics: Airway Obstruction; Body Temperature; Carbon Dioxide; Heart Rate; Humans; Infant, Newborn; Masks; Monitoring, Physiologic; Neonatology; Positive-Pressure Respiration; Resuscitation; Tidal Volume
PubMed: 31493856
DOI: 10.1053/j.semperi.2019.08.006 -
Critical Care Clinics Oct 2016More than 4 decades after the creation of the Brooke and Parkland formulas, burn practitioners still argue about which formula is the best. So it is no surprise that... (Review)
Review
More than 4 decades after the creation of the Brooke and Parkland formulas, burn practitioners still argue about which formula is the best. So it is no surprise that there is no consensus about how to resuscitate a thermally injured patient with a significant comorbidity such as heart failure or cirrhosis or how to resuscitate a patient after an electrical or inhalation injury or a patient whose resuscitation is complicated by renal failure. All of these scenarios share a common theme in that the standard rule book does not apply. All will require highly individualized resuscitations.
Topics: Acute Kidney Injury; Burns; Electric Injuries; Heart Failure; Humans; Liver Cirrhosis; Monitoring, Physiologic; Resuscitation; Smoke Inhalation Injury
PubMed: 27600129
DOI: 10.1016/j.ccc.2016.06.005 -
Seminars in Fetal & Neonatal Medicine Apr 2021Infant resuscitation devices used at birth must be capable of delivering adequate and consistent ventilation in a controlled and predictable manner to a wide patient... (Review)
Review
Infant resuscitation devices used at birth must be capable of delivering adequate and consistent ventilation in a controlled and predictable manner to a wide patient weight range, and combinations of transitional lung states. Manual inflation resuscitation devices delivering positive pressure lung inflation at birth can be classified broadly into two types: 1) flow generating, ie silicone self-inflating bags (SIB) also known as bag valve mask (BVM) and 2) flow dependent, ie anaesthetic flow inflating bag (FIB) and t-piece resuscitator (TPR) systems (eg: Neopuff, GE Panda and Draeger Resuscitaires). Globalization, lower production costs, and an expanding market need for devices, has led to a proliferation of brands (both reusable and single use) within a class type. T-piece resuscitators have become the dominant device particularly in high income countries. There remains a paucity of information on the performance characteristics of these devices and their ability to provide the required respiratory parameters for effective and safe ventilation across the full-expected weight range and lung states to which they will be applied. This review aims to inform current clinical practise on the biomechanical efficiency, reliability and efficacy of the most common devices used to apply PPV to newborns and infants ≤10 kgs.
Topics: Humans; Infant, Newborn; Positive-Pressure Respiration; Reproducibility of Results; Respiration; Respiration, Artificial; Resuscitation
PubMed: 33773952
DOI: 10.1016/j.siny.2021.101233 -
Transfusion Apr 2017
Topics: Blood Transfusion; Humans; Resuscitation
PubMed: 28394422
DOI: 10.1111/trf.14065 -
Clinics in Perinatology Mar 2005Ten percent of all newborns require resuscitation at birth. The Neonatal Resuscitation Program establishes the authoritative technique of newborn resuscitation. Errors... (Review)
Review
Ten percent of all newborns require resuscitation at birth. The Neonatal Resuscitation Program establishes the authoritative technique of newborn resuscitation. Errors continue to occur that are related to the use of unskilled resuscitators; intubation; inadequate suctioning of meconium; and the postresuscitation problems of hypoglycemia, hypocarbia, and hypotension. Specific recommendations are offered to avoid these pitfalls of neonatal resuscitation.
Topics: Carbon Dioxide; Clinical Competence; Humans; Hypoglycemia; Hypotension; Infant, Newborn; Intubation, Intratracheal; Meconium Aspiration Syndrome; Medical Errors; Resuscitation; Suction
PubMed: 15777822
DOI: 10.1016/j.clp.2004.10.002 -
Current Opinion in Pediatrics Apr 2004To provide an overview of neonatal resuscitation practices with an emphasis on interventions that are not currently accepted or adapted into existing resuscitation... (Review)
Review
PURPOSE OF REVIEW
To provide an overview of neonatal resuscitation practices with an emphasis on interventions that are not currently accepted or adapted into existing resuscitation guidelines.
RECENT FINDINGS
Current resuscitation guidelines do not contain specific guidelines for the approach to the extremely low birth weight infant. The differences in environment and management between the neonatal ICU and delivery room are striking and are magnified in the resuscitation of extremely low birth weight infants for whom maintenance of a neutral thermal environment is essential. The use of a polyethylene wrap applied at delivery has been shown to reduce the occurrence of hypothermia and decrease mortality. There is substantial evidence that term and near-term newborn infants can be effectively resuscitated with room air, and recent follow-up studies have demonstrated that this approach is not associated with increased significant differences in neurologic handicap, somatic growth, or developmental milestones when compared with the use of 100% oxygen. The safety and potential benefits of this approach require prospective evaluation in the premature and especially extremely low birth weight infant. There is preexisting evidence that demonstrates that the use of prolonged inflations and t-piece resuscitators may be advantageous during resuscitation, but not all guidelines support these interventions. Although regulated continuous positive airway pressure, pulse oximeters, and blenders are routinely used once an infant is admitted to the neonatal ICU, none of these interventions is recommended in the delivery area. Although prospective studies have demonstrated that the use of colorimetric CO2 detectors significantly decreases the time to recognize misplaced endotracheal tubes placed during resuscitation, their use is not required by current guidelines. The duration of an intubation attempt during resuscitation had never been prospectively evaluated, and our recent findings suggest that a limit of 30 seconds is well tolerated and provides adequate time for a successful attempt.
SUMMARY
There is significant potential for improvement in current resuscitation environments and interventions that will only be realized through further prospective research.
Topics: Body Temperature; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Oximetry; Oxygen Inhalation Therapy; Positive-Pressure Respiration; Resuscitation
PubMed: 15021194
DOI: 10.1097/00008480-200404000-00007 -
European Journal of Trauma and... Apr 2018Permissive hypotensive resuscitation (PHR) is an advancing concept aiming towards deliberative balanced resuscitation whilst treating severely injured patients, and its... (Review)
Review
BACKGROUND
Permissive hypotensive resuscitation (PHR) is an advancing concept aiming towards deliberative balanced resuscitation whilst treating severely injured patients, and its effectiveness on the survival rate remains unexplored. This detailed systematic review aims to critically evaluate the available literature that investigates the effects of PHR on survival rate.
METHODS
A systematic review design searched for comparative and non-comparative studies using EMBASE, MEDLINE, PubMed, Web-of-Science and CENTRAL. Full-text articles on adult trauma patients with low blood pressure were considered for inclusion. The risk of bias and a critical appraisal of the identified articles were performed to assess the quality of the selected studies. Included studies were sorted into comparative and non-comparative studies to ease the process of analysis. Mortality rates of PHR were calculated for both groups of studies.
RESULTS
From the 869 articles that were initially identified, ten studies were selected for review, including randomised control trials (RCTs) and cohort studies. By applying the risk of bias assessment and critique tools, the methodologies of the selected articles ranged from moderate to high quality. The mortality rates among patients resuscitated with low volume and large volume in the selected RCTs were 21.5% (123/570) and 28.6% (168/587) respectively, whilst the total mortality rate of the patients enrolled in three non-comparative studies was 9.97% (279/2797).
CONCLUSIONS
The death rate amongst post-trauma patients managed with conservative resuscitation was lower than standard aggressive resuscitation, which indicates that PHR can create better survival rate among traumatised patients. Therefore, PHR is a feasible and safely practiced fluid resuscitative strategy to manage haemorrhagic shock in pre-hospital and in-hospital settings. Further trials on PHR are required to assess its effectiveness on the survival rate.
LEVEL OF EVIDENCE
Systematic review, level III.
Topics: Adult; Humans; Multiple Trauma; Resuscitation; Shock, Hemorrhagic; Survival Analysis
PubMed: 29079917
DOI: 10.1007/s00068-017-0862-y -
British Medical Journal (Clinical... Jul 1987
Topics: Humans; Medical Staff, Hospital; Resuscitation; State Medicine; United Kingdom
PubMed: 3113637
DOI: 10.1136/bmj.295.6590.71