Does helmet CPAP reduce cerebral blood flow and volume by comparison with Infant Flow driver CPAP in preterm neonates?

OBJECTIVE: We compared neonatal helmet continuous positive airway pressure (CPAP) and the conventional nasal Infant Flow driver (IFD) CPAP in the noninvasive assessment of absolute cerebral blood flow (CBF) and relative cerebral blood volume changes (DeltaCBV) by near-infrared spectroscopy. DESIGN AND SETTING: A randomized crossover study in a tertiary referral NICU. PATIENTS AND INTERVENTIONS: Assessment of CBF and DeltaCBV in 17 very low birth weight infants with respiratory distress (median age 5 days) treated with two CPAP devices at a continuous distending pressure of 4 mbar. MEASUREMENTS AND RESULTS: Neonates were studied for two consecutive 60-min periods with helmet CPAP and with IFD CPAP. Basal chromophore traces enabled DeltaCBV changes to be calculated. CBF was calculated in milliliters per 100 grams per minute from the saturation rise integral and rate of rise O(2)Hb-HHb. Median (range) CBF with helmet CPAP was 27.37 (9.47-48.20) vs. IFD CBF 34.74 (13.59-60.10)(p=0.049) and DeltaCBV 0.15 (0.09-0.28) with IFD and 0.13 (0.07-0.27) with helmet CPAP (NS). Using helmet and IFD CPAP, the neonates showed no difference in mean physiological parameters (transcutaneous carbon dioxide and oxygen tension, pulse oximetry saturation, heart rate, breathing rate, mean arterial blood pressure, desaturation rate, axillary temperature). CONCLUSION: Assessing CBF and DeltaCBV measured by near-infrared spectroscopy with two CPAP devices revealed no differences in relative blood volume, but CBF was lower with helmet CPAP. Greater active vasoconstriction and/or passive capillary and/or venous vessel compression seem the most likely reason, due to a positive pressure around the head, neck, and shoulders by comparison with the airway pressure

Bioenergetics of a slalom kayak (K1) competition

The aim of this study was: i) to compute an energy balance of a slalom kayak competition by measuring the percentage contributions of the aerobic and anaerobic energy sources to total metabolic power (E-tot); and ii) to compare these data with those obtained, on the same subjects, over a flat-water course covered at maximal speed in a comparable time. Experiments were performed on eight middle- to high-class slalom kayakers (24.8 +/- 8.1 years of age, 1.75 +/- 0.04 m of stature, and 69.8 +/- 4.7 kg of body mass) who completed the slalom race in 85.8 +/- 5.3 s and covered the flat water course in 88.1 +/- 7.7 s. E-tot was calculated from measures of oxygen consumption and of blood lactate concentration: it was about 30% larger during the flat water all-out test (1.72 +/- 0.18 kW) than during the slalom race (1.35 +/- 0.12 kW). However, in both cases, about 50% of E-tot derives from aerobic and about 50% from anaerobic energy sources. These data suggest that, besides training for skill acquisition and for improving anaerobic power, some high intensity, cardiovascular conditioning should be inserted in the training programs of the athletes specialised in this sport

PREMATURO DI 32 SETTIMANE DI ETA' GESTAZIONALE CON ERNIA DIAFRAMMATICA CONGENITA (CDH), PORTATORE DI FETOSCOPIC ENDOTRACHEAL OCCLUSION (FETO): PROCEDURA EXIT PER DISOCCLUSIONE ALLA NASCITA E RIPARAZIONE CHIRURCIGA CDH IN TIN

La CDH \ue8 una grave malformazione con una prevalenza alla nascita di circa 1:4000. Nei neonati con CDH isolata, la sopravvivenza dopo l'intervento post-natale \ue8 di circa il 50%, il resto muore a causa di ipoplasia polmonare, ipertensione polmonare, complicanze pre o post intervento. Al fine di ridurre l\u2019ipolasia polmonare, in pochi centri al mondo, viene inserito un balloon occlusivo tracheale mediante fetoscopia (FETO). Con tale tecnica \ue8 stato possibile migliorare la sopravvvivenza di questi casi fino a circa il 50%.Descriviamo la gestione di una neonata sottoposta a FETO a 26 s, per CDH grave, e nata a 32 s per travaglio prematuro. Durante l\u2019EXIT si e\u2019 proceduto ad ecografia tracheale, visualizzazione del balloon, punzione transtracheale dello stesso, intubazione della neonata, taglio del cordone, quindi prosecuzione della rianimazione neonatale su termoculla. Il nostro caso si presta a diverse considerazioni di carattere organizzativo e gestionale dei feti con FETO, nonche\u2019 di gestione del neonato con CDH una volta risolta l\u2019ostruzione tracheale