Sindromul de detresă respiratorie a prematurului
Sindromul de detresă respiratorie (RDS) neonatală reprezintă orice dificultate în respiraţie întâlnită sub vârsta de 28 de zile. În literatura de specialitate se întâlneşte sub denumirea de sindrom de detresă respiratorie a prematurului sau boala membranelor hialine (BMH). Aceasta este determinată de dezvoltarea insuficientă a plămânilor şi de existenţa unui deficit biochimic de surfactant.
Incidenţa afecţiunii este invers proporţională cu vârsta de gestaţie, fiind de aproximativ 40% la nou-născuţii cu vârsta gestaţională de 30-32 săptămâni; de 20% la cei de 32-34 săptămâni şi de 0,5-1% la nou-născuţii la termen. În general, patologia este mai severă la băieţi, care înregistrează forme mai severe de detresă respiratorie.
Surfactantul are rolul de a menţine tensiunea de suprafaţă la nivel alveolar (acţiune antiatelectatică). Pe lângă aceasta, surfactantul ajută la scăderea efortului ventilator şi contribuie la apărarea de infecţii.
Prin reducerea tensiunii de la nivel alveolar şi menţinerea acesteia la un nivel optim, surfactantul previne colapsarea completă a alveolelor în timpul expiraţiei. În plus, existenţa unei tensiuni scăzute la nivelul membranei alveolare permite expansiunea acestora, în momentul inspirării, cu un efort mai mic. În lipsa unei cantităţi suficiente de surfactant, membrana alveolară colapsează, iar cavitatea pulmonară se va deschide foarte greu. În consecinţă, schimbul oxigen-dioxid de carbon la nivelul sângelui care trece prin plămân nu va mai putea avea loc la parametrii optimi.
Sindromul de detresă respiratorie impune folosirea unui sistem de ventilaţie artificială. Sistemele convenţionale de ventialaţie mecanică ajută la salvarea vieţii copiilor născuţi prematur, însă, pot, în acelaşi timp, să le afecteze plămânii. Astfel, au început să fi utilizate metode alternative de tratament al insuficienţei respiratorii. Una din aceste noi terapii este ventilaţia cu frecvenţă înaltă.
Ventilaţia cu frecvenţă înaltă (HFV) este o tehnică nouă de ventilaţie care foloseşte frecvenţe respiratorii care depăşesc cu mult frecvenţa respiratorie normală.
Există trei tipuri de HFV:
1.ventilaţia cu frecvenţă înaltă şi presiune pozitivă (HPPV, frecvenţa 60-150/minute);
2.ventilaţia cu frecvenţă înaltă în jet (HFJV, frecvenţa 100-600);
3.ventilaţia oscilatorie cu frecvenţă înaltă (HFOV, frecvenţa 300-3.000/minut).
HFOV este destinat prematurilor cu greutate foarte mică la naştere, extrem de mică şi incredibil de mică. Este o modalitate de ventilaţie care duce la un număr mai redus de complicaţii şi care creşte rata de supravieţuire.
Avantajul ventilaţiei oscilatorii cu frecvenţă înaltă (HFOV) comparativ cu ventilaţia convenţională cu presiune pozitivă sau ventilaţia cu jet este capacitatea de a promova schimbul gazos folosind volume curente mai mici, ajutând astfel la minimalizarea presiunilor vasculare pulmonare pentru a preveni şi inhiba pierderea de lichid la nivelul membranei alveolo-capilare. Capacitatea HFOV de a ventila şi menţine oxigenarea folosind volume curente minime permite reducerea barotraumei determinată de presiunile prea mari induse de respiraţia artificială şi, în consecinţă, scăderea morbidităţii sau potenţialelor complicaţii pe termen lung asociate ventilaţiei mecanice în RDS.
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Davis said that his back stiffened up after a collision with Dwyane Wade and a couple of tough screens from the Heat. But he felt better on Sunday and plans to play in Game 2.
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"It's tough, but I'm not one to make excuses," Woodson said. "We're going to have to play."
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MILWAUKEE (AP) — President Barack Obama's administration launched a multi-pronged assault on Mitt Romney's values and foreign policy credentials Sunday, while a fresh set of prominent Republicans rallied behind the GOP front-runner as the odds-on nominee, further signs the general election is overtaking the primary season.
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A defiant Rick Santorum outlined plans to leave Wisconsin the day before the state's contest Tuesday, an indication that the conservative favorite may be in retreat, his chances to stop Romney rapidly dwindling.
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"I think Gov. Romney's a little out of touch," Biden told CBS' "Face the Nation" in an interview broadcast Sunday. "I can't remember a presidential candidate in the recent past who seems not to understand, by what he says, what ordinary middle-class people are thinking about and are concerned about."
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Romney casually bet a rival $10,000 during a presidential debate, noted that his wife drives a "couple of Cadillacs," and lists owners of professional sports teams among his friends. His personal tax records show investments in the Cayman Islands and a Swiss bank account.
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Biden said Obama was "stating the obvious" when he told Russian President Dmitry Medvedev that he would have more latitude on missile defense after the November general election. The two presidents did not realize the exchange, during a meeting in Seoul, South Korea, last weekend, was being picked up by a microphone.
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"Speaking of flexible, Gov. Romney's a pretty flexible guy on his positions," Biden said. Romney's GOP opponents have accused the former Massachusetts governor of "flip-flopping" on issues such as health care and abortion.
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Rep. Paul Ryan, R-Wis., spent the weekend at Romney's side campaigning across Wisconsin, one of three states to host Republican primaries Tuesday. First-term Sen. Ron Johnson, R-Wis., followed Ryan's lead Sunday morning.
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adad 2 Aprilie, 2012 - 08:52
MILWAUKEE (AP) — President Barack Obama's administration launched a multi-pronged assault on Mitt Romney's values and foreign policy credentials Sunday, while a fresh set of prominent Republicans rallied behind the GOP front-runner as the odds-on nominee, further signs the general election is overtaking the primary season.
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A defiant Rick Santorum outlined plans to leave Wisconsin the day before the state's contest Tuesday, an indication that the conservative favorite may be in retreat, his chances to stop Romney rapidly dwindling.
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Both Secretary of State Hillary Clinton and Vice President Joe Biden went after Romney Sunday, underscoring the belief inside Obama's Chicago re-election headquarters that Romney will — sooner than later — secure the right to face Obama this fall. Romney largely agreed, telling a Madison, Wis., crowd Sunday night that the nominee "will probably be me."
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"I think Gov. Romney's a little out of touch," Biden told CBS' "Face the Nation" in an interview broadcast Sunday. "I can't remember a presidential candidate in the recent past who seems not to understand, by what he says, what ordinary middle-class people are thinking about and are concerned about."
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The line of attack is likely to play prominently in the Obama campaign's general election narrative. While Obama is a millionaire, Romney would be among the nation's wealthiest presidents ever elected. And he's opened himself to criticism through a series of missteps.
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Romney casually bet a rival $10,000 during a presidential debate, noted that his wife drives a "couple of Cadillacs," and lists owners of professional sports teams among his friends. His personal tax records show investments in the Cayman Islands and a Swiss bank account.
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Biden said Obama was "stating the obvious" when he told Russian President Dmitry Medvedev that he would have more latitude on missile defense after the November general election. The two presidents did not realize the exchange, during a meeting in Seoul, South Korea, last weekend, was being picked up by a microphone.
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Rep. Paul Ryan, R-Wis., spent the weekend at Romney's side campaigning across Wisconsin, one of three states to host Republican primaries Tuesday. First-term Sen. Ron Johnson, R-Wis., followed Ryan's lead Sunday morning.
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baiyunyouyou 31 Martie, 2012 - 11:39
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