2.50
Hdl Handle:
http://hdl.handle.net/10755/158214
Type:
Presentation
Title:
Ventilator Inspired Gas Temperature And Tracheal Injury In Neonates
Abstract:
Ventilator Inspired Gas Temperature And Tracheal Injury In Neonates
Conference Sponsor:Western Institute of Nursing
Conference Year:2001
Author:Loan, Lori, PhD
P.I. Institution Name:Madigan Army Medical Center
Title:Research Scientist
Contact Address:Bldg 9040 Fitzsimmons Drive, Tacoma, WA, 98431, USA
Contact Telephone:253.968.2289
PROBLEM: The beneficial effects of heated and humidified ventilation have been demonstrated by clinical studies on infants requiring mechanical respiratory support, but while authors agree on the amount of humidity to use, the control of airway temperature is routinely arbitrary because the ideal temperature of inspired gases for infants receiving conventional ventilation has not been determined. Infants may receive excessively warm or cool gases causing mucosal damage to the tracheal epithelium. SPECIFIC AIM: The purpose of the study was to build on previous work on ventilator inspired gas temperature induced histopathologic alterations in the tracheal epithelium. The study aim was to examine the effect of six commonly used ventilator inspired gas temperatures (32o C, 33o C, 34o C, 35o C, 36o C and 37o C) on tracheal injury. CONCEPTUAL FRAMEWORK: In order to distinguish tracheal injury caused by heated ventilator inspired gases from injury resulting from by other sources, a framework for categorizing factors attributing to tracheal wounding was formulated. This neonatal tracheal wounding framework provided the conceptual foundation for the study. SAMPLE: The sample included thirty-five cross section slides from the 6th intratracheal ring from intubated, non-suctioned newborn piglets completing the original studies. METHODS: The study was a secondary analysis of existing data from two previous studies (Loan, 1992; Turner, Loan & Harwood, 1994). The original studies utilized experimental designs with random assignment of subjects to a control group (n=5) or one of six treatment groups (n=5 in each group). Computer Video Image Analysis was employed to collect histopathologic measurements of tracheal epithelial acute response to injury including percentage of cilia loss, number and size of goblet cells remaining, epithelial thickness, cilia length, and polymorphonuclear leukocyte infiltrations. RESEARCH FINDINGS: Results indicated that damage to the epithelium was mild to severe, and for the most part, not statistically significantly different when inspired gases were delivered at varying temperatures. Statistically significant differences between groups for cilia length (p = .000) and epithelial thickness (p = .000) were noted. Cilia were shorter when gases were delivered at 34o C, 35o C and 37o C (p .01, .02 and .03 respectively). Specimen from subjects receiving inspired gases heated to 32o C and 35o C had a thinner tracheal epithelium as compared to controls (p .012 and .005 respectively). There were no statistically significant differences in cilia loss, number and size of goblet cells, and polymorphonuclear leukocyte infiltrations. CONCLUSIONS: Although epithelial thickness and cilia length were in some cases significantly different from the norm, no satisfactory clinical explanation is forthcoming because significant differences were scattered sporadically among the inspired gas temperatures. This study validates the findings from past work describing some degree of tracheal epithelial damage occurring within six hours of mechanical ventilation instilling room air and low positive pressures. Although epithelial thickness and cilia length were in some cases significantly different from the norm, these findings do not lend insight to substantiate or refute the use on any one ventilator inspired gas temperature. Therefore, at the present time, no single ventilator inspired gas temperature is recommended more highly than the others.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleVentilator Inspired Gas Temperature And Tracheal Injury In Neonatesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158214-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Ventilator Inspired Gas Temperature And Tracheal Injury In Neonates</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Loan, Lori, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Madigan Army Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Research Scientist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Bldg 9040 Fitzsimmons Drive, Tacoma, WA, 98431, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">253.968.2289</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">lori.loan@nw.amedd.army.mil</td></tr><tr><td colspan="2" class="item-abstract">PROBLEM: The beneficial effects of heated and humidified ventilation have been demonstrated by clinical studies on infants requiring mechanical respiratory support, but while authors agree on the amount of humidity to use, the control of airway temperature is routinely arbitrary because the ideal temperature of inspired gases for infants receiving conventional ventilation has not been determined. Infants may receive excessively warm or cool gases causing mucosal damage to the tracheal epithelium. SPECIFIC AIM: The purpose of the study was to build on previous work on ventilator inspired gas temperature induced histopathologic alterations in the tracheal epithelium. The study aim was to examine the effect of six commonly used ventilator inspired gas temperatures (32o C, 33o C, 34o C, 35o C, 36o C and 37o C) on tracheal injury. CONCEPTUAL FRAMEWORK: In order to distinguish tracheal injury caused by heated ventilator inspired gases from injury resulting from by other sources, a framework for categorizing factors attributing to tracheal wounding was formulated. This neonatal tracheal wounding framework provided the conceptual foundation for the study. SAMPLE: The sample included thirty-five cross section slides from the 6th intratracheal ring from intubated, non-suctioned newborn piglets completing the original studies. METHODS: The study was a secondary analysis of existing data from two previous studies (Loan, 1992; Turner, Loan &amp; Harwood, 1994). The original studies utilized experimental designs with random assignment of subjects to a control group (n=5) or one of six treatment groups (n=5 in each group). Computer Video Image Analysis was employed to collect histopathologic measurements of tracheal epithelial acute response to injury including percentage of cilia loss, number and size of goblet cells remaining, epithelial thickness, cilia length, and polymorphonuclear leukocyte infiltrations. RESEARCH FINDINGS: Results indicated that damage to the epithelium was mild to severe, and for the most part, not statistically significantly different when inspired gases were delivered at varying temperatures. Statistically significant differences between groups for cilia length (p = .000) and epithelial thickness (p = .000) were noted. Cilia were shorter when gases were delivered at 34o C, 35o C and 37o C (p .01, .02 and .03 respectively). Specimen from subjects receiving inspired gases heated to 32o C and 35o C had a thinner tracheal epithelium as compared to controls (p .012 and .005 respectively). There were no statistically significant differences in cilia loss, number and size of goblet cells, and polymorphonuclear leukocyte infiltrations. CONCLUSIONS: Although epithelial thickness and cilia length were in some cases significantly different from the norm, no satisfactory clinical explanation is forthcoming because significant differences were scattered sporadically among the inspired gas temperatures. This study validates the findings from past work describing some degree of tracheal epithelial damage occurring within six hours of mechanical ventilation instilling room air and low positive pressures. Although epithelial thickness and cilia length were in some cases significantly different from the norm, these findings do not lend insight to substantiate or refute the use on any one ventilator inspired gas temperature. Therefore, at the present time, no single ventilator inspired gas temperature is recommended more highly than the others.</td></tr></table>en_GB
dc.date.available2011-10-26T20:37:26Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:37:26Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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