Evaluation of ventilatory parameters, inflammatory biomarkers in preterms ventilated with either PSV+VG or SIMV+VG

Hacim garanti (VG) ventilasyon yenidoğanlarda sıklıkla kullanılmaktadır. Hacim garanti seçeneği en çok SIMV veya A/C modlar ile birlikte kullanılır. Bu çalışmanın amacı PSV+VG ve SIMV+VG modlarının ventilatör parametreleri, inflamatuar belirteçler ve klinik bulgulara olan etkilerini incelemektir. Gebelik haftası 37 haftadan küçük olan, ilk 12 saat içerisinde mekanik ventilasyon tedavisine ihtiyaç gösteren hastalar çalışmaya dahil edilmiştir. Hastalar surfaktan tedavisinden sonra SIMV+VG veya PSV+VG modlarına randomize edilmiştir. Mekanik ventilasyon tedavisi Drager Babylog 8000+ ile yapılmıştır. Ayarlanan ve ölçülen parametreler, "Babyview" programı ile 10 saniye aralıklarla bilgisayara aktarılmıştır. Kayıt, hasta ekstübe olana kadar yada 72 saatlik olana kadar (hangisi önceyse) sürdürülmüştür. Kayıtlarda tedavi ve ventilatörden ayrılma dönemi belirtilmiştir. Ölçülen pik inspiratuar basınç (PIP), ayarlanan ve ölçülen tidal hacim (TV) ve solutulan oksijen konsantrasyonu (FiO2) incelenmiştir. Ölçülen TV ayarlanan TV'nin %80 120'si arasında ise "istenen TV" olarak kabul edilmiştir. Hastalardan iki kere trakeal aspirat alınmıştır; birinci alım surfaktan tedavisinden altı saat sonra ve ikinci alım ventilatör parametrelerinin kaydı sonlanırken yapılmıştır. Trakeal aspirattan IL-1&#946;, IL-6, IL-8, IL-10 ve TNF-&#945; çalışılmıştır. Çalışmaya 42 hasta (21 PSV+VG, 21 SIMV+VG) alınmıştır. Ortanca gebelik haftası iki grupta 29 hafta ve doğum ağırlıkları ise PSV+VG ve SIMV+VG gruplarında sırasıyla 980,0 ve 870,0 gr bulunmuştur. Uygun TV verilme oranı PSV+VG grubunda SIMV+VG grubuna göre daha fazla bulunmuştur. Tedavi dönemi soluklarında PSV+VG grubunda SIMV+VG grubuna göre tidal hacimlerin daha stabil olduğu görülmüştür. PIP, MAP ve FiO2 ölçümleri iki grupta benzer saptanmıştır. İkinci örneklem zamanındaki IL-1&#946; düzeyleri birinci örneklem zamanındaki düzeye göre iki grupta da artmıştır. Artış yüzdesi iki grupta da benzer bulunmuştur. İkinci örneklem zamanındaki IL-8 düzeyleri birinci örneklem zamanındaki düzeye göre sadece PSV+VG grubunda artmıştır. IL-6, IL-10 ve TNF-&#945; düzeylerinin iki grupta ve grup içinde iki zamanda da benzer olduğu görülmüştür. Hipokarbi, hiperkarbi, hiperoksi ve hipoksi oranları iki grupta benzer saptanmıştır. PSV+VG grubundaki hastaların nabız düzeyleri SIMV+VG grubuna göre daha düşük ve daha stabil bulunmuştur. Akut ve kronik prematürite problemleri PSV+VG ve SIMV+VG gruplarında farklı saptanmamıştır. PSV+VG ventilasyonun olumsuz sonuçlara yol açmadan daha fazla uygun TV sağladığı gösterilmiştir. Bu durum, ekspiratuar-inspiratuar senkronizasyonu daha iyi sağladığı bilinen PSV+VG modunun akciğer hasarını artırmadan, daha fazla oranda istenen oranda TV vermesi nedeniyle respiratuar distresin mekanik ventilasyon tedavisi sırasında güvenle kullanılabileceğini desteklemektedir.Volume guarantee (VG) ventilation is frequently used for newborns, mostly combined with SIMV or A/C modes. Aim of this study was to compare effects of SIMV+VG or PSV+VG ventilation on ventilatory parameters, inflammtory biomarkers and clinical findings. Preterms with RDS < 37th gestational age (GA)requiring mechanical ventilation in the first 12 hours were randomized to either SIMV+VG or PSV+VG after surfactant treatment. Patients were ventilated with Draeger Babylog 8000+. Set and measured ventilatory parameters were downloaded by Babyview® software for 72 hours unless extubation or need for HFO ventilation occurred. Actual peak inspiratory pressure (PIP), set and measured tidal volume (TV), mean airway pressure (MAP) and FiO2 were analyzed. If measured TV percentage was between 80-120 % of set TV, it was considered appropriate. Tracheal aspirate specimens were collected twice; first at the sixth hour after surfactant treatment and second before extubation or HFO ventilation or 72nd hour of the randomized ventilation mode. IL-1&#946;, IL-6, IL-8, IL-10 and TNF-&#945; were analysed. Statistical analyses were performed with SPSS v15. Forty-two patients (21 PSV+VG, 21 SIMV+VG) were enrolled. Median GA were 29 weeks and BW were 980,0 and 870,0 gr in each group. Demographic characteristics were similar. "Appropriate TV" was higher PSV+VG group. TVs were more stable throughout treatment period breaths in PSV+VG group compared to SIMV+VG group. PIP, MAP and FiO2 were similar in two groups. IL-1&#946; levels were found to be higher in second sampling time in both groups. The increase rate of IL-1&#946; were similar in two groups. Significant increase in second sampling time in IL-8 levels were found only in PSV+VG group. IL-6, IL-10 and TNF-&#945; levels were similiar both in between two groups and two sampled times within each group. Hypocarbia, hypercarbia, hyperoxemia and hypoxemia incidences were not different between groups. PSV+VG group was less tachycardic than SIMV+VG group. Acute and chronic prematurity problems including chronic lung disease (CLD) defined as oxygen requirement at 36th postmentrual age were not different. PSV+VG was associated with higher "appropriate TV" without any adverse effects and similar CLD occurence. These findings can support the beneficial use of PSV+VG which is more physiological due to better inspiratory expiratory synchrony

The effect of using alpaca and silk instead of wool in weft yarns on the woollen fabric properties

In this study, the effect of using silk or alpaca weft yarns on fabric properties and dyeing behavior in the production of woollen woven fabrics was investigated. Therefore, three different fabric types with two different weft densities were produced, and the mass per unit area, tensile strength, comfort properties, such as air permeability and water vapor permeability have been tested. The fabrics were then dyed with reactive dyestuffs recommended for wool, and the color (color yield (K/S) and CIEL*a*b*) and fastness (washing and light) properties of the fabrics after dyeing were compared. The results of the permeability measurements showed that based on the fiber type used to produce woven fabrics affected these properties. However, the most attractive result was obtained in the dyeing of silk containing woollen fabrics. It was observed that in case of weaving fabrics according to various designs using wool and silk in weft and warp yarns separately, two different tones can be obtained on the same fabric, that is, a bicolor effect.Namik Kemal UniversityNamik Kemal University [NKUBAP.06, GA16.040]We would like to thank Namik Kemal University for supporting this study within NKUBAP.06.GA16.040 coded project

Grading the level of evidence of neonatal pharmacotherapy:midazolam and phenobarbital as examples

Background: Many drugs are used off-label or unlicensed in neonates. This does not mean they are used without evidence or knowledge. We aimed to apply and evaluate the Grading and Assessment of Pharmacokinetic–Pharmacodynamic Studies (GAPPS) scoring system for the level of evidence of two commonly used anti-epileptic drugs. Methods: Midazolam and phenobarbital as anti-epileptics were evaluated with a systematic literature search on neonatal pharmacokinetic (PK) and/or pharmacodynamic [PD, (amplitude-integrated) electroencephalography effect] studies. With the GAPPS system, two evaluators graded the current level of evidence. Inter-rater agreement was assessed for dosing evidence score (DES), quality of evidence (QoE), and strength of recommendation (REC). Results: Seventy-two studies were included. DES scores 4 and 9 were most frequently used for PK, and scores 0 and 1 for PD. Inter-rater agreements on DES, QoE, and REC ranged from moderate to very good. A final REC was provided for all PK studies, but only for 25% (midazolam) and 33% (phenobarbital) of PD studies. Conclusions: There is a reasonable level of evidence concerning midazolam and phenobarbital PK in neonates, although using a predefined target without integrated PK/PD evaluation. Further research is needed on midazolam use in term neonates with therapeutic hypothermia, and phenobarbital treatment in preterms. Impact: There is a reasonable level of evidence concerning pharmacotherapy of midazolam and phenobarbital in neonates. Most evidence is however based on PK studies, using a predefined target level or concentration range without integrated, combined PK/PD evaluation.Using the GAPPS system, final strength of recommendation could be provided for all PK studies, but only for 25% (midazolam) to 33% (phenobarbital) of PD studies.Due to the limited PK observations of midazolam in term neonates with therapeutic hypothermia, and of phenobarbital in preterm neonates these subgroups can be identified for further research.</p