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D Miguet

Publications and source records attributed to D Miguet.

8 recordsLinked to original sources
PubMed1994

Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia.

OBJECTIVES: a) To assess the efficiency of preoperative stabilization with the use of high-frequency oscillatory ventilation in the treatment of congenital diaphragmatic hernia; b) to determine early prognosis factors. DESIGN: Prospective, consecutive patient study. SETTING: A tertiary neonatal intensive care unit in a university hospital. PATIENTS: All patients admitted to the neonatal intensive care unit with a diagnosis of congenital diaphragmatic hernia between April 1990 and June 1993 (n = 18). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven infants had an antenatal diagnosis. Ventilatory settings, blood gas values, arterial-alveolar oxygen ratio, and oxygenation index were recorded on admission and every 3 hrs thereafter until surgery. Surgery was performed if the FIO2 was < 0.3 and mean airway pressure was approximately 9 cm H2O, while the infants were ventilated with high-frequency oscillation. Mean duration of high-frequency oscillatory ventilation was 57 +/- 52 hrs before surgery and 60 +/- 104 hrs after surgery. Overall survival rate was 72%. Infants were divided into two groups, according to the time of surgery. Group 1 (n = 12) patients were operated on in the first 48 hrs of life; on admission, all group 1 patients had an arterial-alveolar oxygen ratio of > or = 0.3 and an oxygenation index of < or = 10, and all recovered. Group 2 (n = 6) consisted of patients for whom preoperative stabilization was difficult to achieve. One infant died before surgery. Four other infants had congenital malformations and subsequently died. Only one infant survived. In this group, the arterial-alveolar oxygen ratio and oxygenation index on admission were 0.08 +/- 0.05 and 33.2 +/- 14.6, respectively (p < .01 vs. group 1). CONCLUSIONS: a) This study demonstrated the efficiency of preoperative stabilization using high-frequency oscillation in the treatment of congenital diaphragmatic hernia. b) An arterial-alveolar oxygen ratio of > or = 0.3 and an oxygenation index of < or = 10 on admission are associated with a rapidly completed surgical procedure and a good outcome.

Female↗
PubMed1994

[Persistence of fetal circulation and high frequency oscillation].

High frequency ventilation (HVF) was used in 17 newborns with severe respiratory distress due to persistent fetal circulation. All patients except one had been treated previously but not satisfactorily by conventional ventilation. Four children died from neurological causes despite respiratory improvement. HVF failed in one case. Twelve newborns recovered without any sequelae. Thus HVF appears to be a most valuable ventilation technique in this situation.

Blood Gas Monitoring, Transcutaneous↗
PubMed1994

[High frequency oscillation ventilation after surfactant use in hyaline membrane disease. Outcome of ventilation parameters].

Surfactant therapy in hyaline membrane disease (HMD) does not suppress all risks of subsequent broncho-pulmonary dysplasia. This study aimed to estimate the efficacy of Surfexo followed by high frequency ventilation (HFV) on respiratory parameters and long term outcome. 47 neonates (44 premature) with HMD received first Surfexo then HFV whenever hypercarbia (pH < 7.25, PaCO2 > 7 kPa) and/or hypoxaemia (PaO2 < 7kPa, FiO2 = 0.5) continued. Surfactant was given at 3 hours of life (mean), HFV was started at 5 h (mean) and continued for 36 h (mean). FiO2 was lowered after a HFV of 3 h (p < 0.01) and mean broncho-tracheal pressure decreased after 12 h (p < 0.001). Six children deceased (1 from massive pulmonary haemorrhage, 5 from neurological complications), 1 developed pneumothorax (this was the only barotraumatic complication in our series), 2 children had a mild broncho-pulmonary dysplasia. All the 38 remaining patients had a good uncomplicated outcome. Thus Surfexo -HFV association appears to be an excellent therapy of HMD in newborns.

Birth Weight↗
PubMed1994

[High frequency ventilation in neonatal surgery].

High frequency oscillatory ventilation (HFOV) is one of the artificial ventilation techniques used for the treatment of severe respiratory distress in the neonatal period. We studied (between 1987 and 1992) 57 newborn infants ventilated by HFOV during surgery. The aim was to facilitate the surgical procedure without having any deleterious effects on the gas exchange or the hemodynamic state of the infant. Three groups were studied. Group I (thoracic procedures: oesophageal atresia and pulmonary malformations, n = 25), group II (diaphragmatic hernia, n = 22), group III (abdominal procedures, n = 10). In the thoracic surgery group, no deleterious effect related to the HFOV was reported. The hyperventilation noticed after anaesthetic induction was rapidly corrected by placing the patient in a lateral position. In the three groups, no intraoperative complications related to the HFOV were observed. The diaphragmatic hernia group was divided into two subgroups according to the timing of surgery (emergency surgery, surgery after stabilization). In the latter subgroup, surgery was performed when the ventilation and gas exchange conditions had significantly improved. This subgroup showed the highest survival rate. This technique of peroperative ventilation is specifically used in the thoracic and diaphragmatic procedures of term and preterm newborn infants. It achieves a more stable operative field with less pulmonary expansions and diaphragmatic movements. In spite of the fact that HFOV is seldom used during anaesthesia, this study confirms its safety as well as the simplicity of its monitoring.

Birth Weight↗
PubMed1994

[Congenital diaphragmatic hernia: results of the association of preoperative stabilization and oscillation ventilation. (A prospective study of 17 patients)].

The authors studied the efficacy of ventilation by high frequency oscillation in preoperative stabilization of 17 newborns with diaphragmatic hernia. This prospective study covered the pre-, intra- and postoperative periods. The preparation to surgery lasted 57 +/- 52 hr. The newborns were operated at 61 +/- 46 hr of life and the duration of postoperative mechanical ventilation was 184 +/- 200 hours. Two groups were differentiated retrospectively. The first group (n = 11) comprises neonates in whom a good preoperative stabilization was obtained and who underwent surgery before 48 hours. In this group all children survived at one month of life (one infant died at six months from cardiac malformation during heart surgery). The second group (n = 6) consists of neonates having required a longer time for stabilization. The operation was performed on the fifth day only. After one month, 5 children survived (one newborn died from intractable hypoxaemia at 5 days of life, surgical cure being impossible; 3 infants died belatedly from associated severe malformations). Predictive factors can be individualized: arteriolar-alveolar ratio, associated abnormalities and particularly these concerning heart, oxygenation index at birth, time required to stabilize the newborn condition. Nevertheless, the association of preoperative stabilization and ventilation by high frequency oscillation appears to improve the prognosis of congenital diaphragmatic hernia.

Birth Weight↗
PubMed1992

[Neonatal gastric necrosis].

BACKGROUND: Neonatal necrotizing gastritis is rare. It is usually a complication of acute anoxia or shock and its diagnosis is essentially radiological. CASE REPORTS: Case no. 1: a boy was born at the 36th week of a pregnancy complicated by preeclampsia. Perinatal asphyxia necessitated delivery by cesarean section. He presented with neonatal respiratory distress which was complicated by pneumothorax. On the 5th day of life, the abdomen was distended and the newborn had still not been fed. On the 6th day, X-rays showed pneumatosis of the gastric wall associated with pneumoperitoneum. Surgery showed an area of necrosis on the posterior surface of the stomach with a small perforation, which was stitched. The child was fed 5 days later and was in good condition at the age of 6 months. Case no. 2: a girl was born at the 35th week of a pregnancy complicated by asthma during the second trimester. Perinatal asphyxia and abnormal fetal rhythm led to delivery by cesarean section. At 24 hour of life, she vomited blood and fibroscopy confirmed the presence of blood in the stomach. On the 3rd day, blood vomiting appeared again, associated with abdominal distension. X-rays showed pneumatosis of the gastric wall; fibroscopy showed necrosis of the lower 2/3 of the stomach. Feeding was stopped and the child was given cimetidine. Refeeding was possible when the girl was 10 days old, and she was in good condition at the age of 6 months. CONCLUSION: Neonatal gastric necroses and necrotizing enterocolitis have many similar features. Medical therapy is often effective, but surgery is mandatory when necrotizing gastritis is complicated by perforation.

Female↗