Background: High-frequency oscillatory Ventilation (HFOV) has been shown to result in less lung injury. HFOV is also used in critically ill newborns when Conventional Mechanical Ventilation (CV) fails, especially in units with lack of nitric oxide (NO) and extracorporeal membrane oxygenation. Objectives: There are no recent data on the response of newborns to rescue HFOV (rHFOV) in the literature. The aim of this study was to evaluate the risk factors that affect the response to rHFOV in newborns who had CV failure in respiratory support. Methods: Newborns who still had a respiratory failure in case of CV and switched to rHFOV were grouped as survived and died. The characteristics of the patients such as birth weight (BW), gestational age (GA), and disease, in addition to ventilator settings, arterial blood gas analysis, Ventilation duration, and side effects were compared between the groups. Results: 84 patients with a mean GA of 32. 1  5. 3 weeks and a mean BW of 1901  1135 g were enrolled in the study. The patients were switched to rHFOV at median 28. 5 hours of life. Infants who died had lower BW (1345 935 g vs. 2557 1035 g, P = 0. 0001) and lower GA (31. 7  4. 9 weeks vs. 34. 8  4. 4 weeks, P = 0. 03) in comparison with infants who survived. Prematurity (OR: 7. 73, 95% CI: 2. 1-24. 7, P = 0. 001) and having BW < 1500 g (OR: 7. 02, 95% CI: 2. 6-18. 6, P < 0. 001) increased mortality significantly. Cut-off values for BW and GA were found to be 1875 g and 32. 5 weeks with 75% sensitivity and 78% specificity. There were no differences in the initial Ventilation settings between the groups and no correlation between the side effects such as intraventricular hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia could be demonstrated with the duration of rHFOV. Conclusions: rHFOV in case of CV failure is more effective in patients with greater GA andBW, independent of the disease and initial rescue ventilator settings.

BACKGROUND: Endotracheal or tracheostomy tube in Mechanically ventilated patients disturb verbal communication with others. Therefore, patients are frustrated of requesting for their needs or problems related to artificial breathing. Therefore investigating self-experiences of these patients can be applied in providing them with a better care by clinical personnel.METHODS: This is a qualitative phenomenological survey. The study population was patients who were Mechanically ventilated at least for one time and were more than 12 years old. Data were collected during five months by deep interview and then were analyzed by Collizi's seven–stage method.RESULTS: The findings of this research were classified in 139 codes and 3 categories as: 1) Interpersonal experiences, 2) Extra personal experiences and 3) Intrapersonal experiences.CONCLUSION: Mechanically ventilated patients tolerate many stressors, which many of them are externally sustained. Better care will reduce these stressors, and make it easier for the patients to get along with the artificial breathing. Meanwhile some pleasure experiences had been mentioned by patients in this study.

Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus Conventional ultrafiltration (CUF) on duration of Mechanical Ventilation and hemodynamic status in children undergoing congenital heart surgery. Materials and Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of Mechanical Ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups.Results: At immediate post-MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P<0.05) only in the study group. Furthermore, there was a significant difference in time of Mechanical Ventilation (P=0.004) and ICU stay (P=0.007) between the two groups. Inotropes including milrinone (P=0.04), epinephrine (P=0.001), and dobutamine (P=0.002) were used significantly less frequently for patients in the intervention than the control group.Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of Mechanical Ventilation and inotrope requirement within 48 h after surgery.

Background: Respiratory failure is a major problem in neonatal medicine in all over the world and has different causes. Using Mechanical Ventilation is one of its major treatments.Objectives: Different strategies have been expressed in this context, including high frequency Mechanical Ventilation.Patients and Methods: This study is a prospective randomized clinical trial conducted on all newborns with respiratory failure hospitalized in the NICU of Tehran vali-asr Hospital during 2009.These patients were divided in to two groups through block Randomization method; Conventional Mechanical Ventilation group and high frequency Ventilation group.Results: Intraventricular hemorrhage (IVH) and air leak (e.g. pneumothorax) were less in HFPPV group than Conventional group (P=0.012 and P=0.038). The mean time needed for Mechanical Ventilation was lower in HFPPV group, but this difference was not statistically significant (P=0.922). Needing to O2 in 28 days of age was almost equal in both groups (P=0.99). Mortality, and refractory hypoxia and PVL were lower in HFPPV group, but the difference was not statistically significant (P=0.301, P=0.508, P=0.113).Conclusions: Treatment of neonatal respiratory failure with high rate Mechanical Ventilation may reduce some complications.

Objective: Air leak syndromes including pneumothorax, pneumomediastinum and pulmonary interstitial emphysema are frequent in neonatal period. Mechanical Ventilation with positive pressure is one of the most common causes of these syndromes. The aim of this study was to evaluate predisposing factors and incidence of pneumothorax in newborns under Mechanical Ventilation.Methods: This descriptive cross sectional study was performed in 400 newborns under Mechanical Ventilation in intensive care unit of a teaching hospital in Iran from April 2004 to December 2008. Predisposing factors leading to Ventilation and incidence of air leak syndromes were studied. Sex, gestational age, birth weight, type of delivery, history of surfactant replacement therapy, ventilator settings and mortality rate were recorded. Statistical analysis was done using SPSS software. Univariate analysis and regression analysis were considered.Findings: Among 400 patients under Mechanical Ventilation, 102 neonates developed pneumothorax (26%). Fifty six (54.9%) of them were boys and 46 (45.1%) girls.54.9% of newborns with pneumothorax were preterm and 45.1% term. Birth weight less than 2500g was recorded in 59.8%. Fifty two percent of these neonates were born by cesarean section vs.32% of newborns without pneumothorax. The most common type (62.7%) of Ventilation leading to pneumothorax was Inspiratory Positive Pressure Ventilation (IPPV). Surfactant replacement therapy was recorded in 32.4% of cases with pneumothorax compared to 60.4% of neonates under Ventilation without pneumothorax, which was significantly different (P=0.017).Conclusion: In newborns surfactant replacement therapy can reduce the risk of pneumothorax caused by Mechanical Ventilation.

Background/Objective: Air leak syndromes are frequent in neonatal period. Mechanical Ventilation with positive pressure is one of the most common causes of these syndromes. The aim of this study was to detect the incidence of pneumothorax in newborns under Mechanical Ventilation.Patients and Methods: This descriptive cross sectional study was performed on 400 newborns admitted in the intensive care unit of 22 Bahman Hospital of Mashhad during 1383-1387. All patients were under Mechanical Ventilation. Sex, gestational age, birth weight, type of delivery, history of surfactant therapy and mortality rate after pneumothorax were recorded in questionnaires. Statistical analysis was done on the obtained data using SPSS software.Results: Among 400 patients under Ventilation, 102 neonates developed pneumothorax (26%). 55% of these cases were boys and 45% were girls. Pneumothorax was on the right side in 66.7%, on the left side in 12.8% and bilateral in 19.6%. In newborns with pneumothorax 54.9% were preterm and 45.1% were term. Birth weight less than 2500g was seen in 59.8% of the cases. Among these neonates 19.6% were very low birth weight (under 1500g). In newborns with pneumothorax, 52% were born with cesarean section and 48% with normal vaginal delivery which was significantly different (P= 0.015). Surfactant therapy was recorded in 32.4% of cases with pneumothorax. The most common type of Ventilation leading to pneumothorax was Synchronized Intermittent Mandatory Ventilation (SIMV) in 51%, Conventional Ventilation and Continious Positive Airway Pressure (CPAP) were seen in 35% and 12.3% of pneumothoraces, respectively. Conclusion: Male sex, prematurity, birth weight below 2500g, cesarean section, negative history of surfactant therapy were risk factors of neonatal pneumothorax. CPAP was the least common kind of Ventilation in pneumothorax cases.

Traumatic chest injury is one the most important factors for total morbidity and mortality in traumatized emergency patients (1). Chest trauma is the cause of 20% to 25% of the trauma-related deaths per year in the United States and is the leading cause of death in the first four decades of life (2). Traumatic chest injuries often occur in combination with other severe injuries, such as head, brain, extremity and abdominal injuries (3). Traumatic chest trauma can occur after car and motor accident, assaults, falls and explosive blasts via a variety of different mechanisms. Overall, car and motor accidents account for 70% to 80% of all thoracic injuries (4).