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M Sánchez Luna

Publications and source records attributed to M Sánchez Luna.

12 recordsLinked to original sources
PubMed2005

[Rescue treatment with inhaled nitric oxide in preterm newborns with respiratory failure].

Inhaled nitric oxide (iNO) is indicated in near-term (> 34 weeks' gestation) and term newborns with hypoxemic respiratory failure and persistent pulmonary hypertension, decreasing the need for extracorporeal membrane oxygenation support in at least 40 %. Currently the use of iNO has not been approved for premature neonates, and its therapeutic efficacy in this group remains controversial. However, it has been suggested that iNO may be helpful by improving oxygenation and reducing the need for aggressive mechanical ventilation in some cases of severe hypoxemic respiratory failure in preterm infants with inadequate response to conventional treatment. We report the cases of three hypoxemic preterm neonates unresponsive to conventional treatment in whom the use of iNO was effective in the management of hypoxemic respiratory failure.

Female↗
PubMed2004

[Diagnosis and management of necrotizing tracheobronchitis].

OBJECTIVE: Necrotizing tracheobronchitis has been described as a complication of mechanical ventilation of newborns with respiratory failure. Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction that causes 45% of mortality. The objective of our study is to analyze our experience in the management of these patients. MATERIAL AND METHODS: In the last three years we have treated eight patients with necrotizing tracheobronchitis The mean age was 0.84 +/- 0.95 months, gestational age of 37.43 +/- 2.3 weeks. The mean weight was 3.07 +/- 1.04 kg. Five patients had a congenital heat disease (62.5%) and three have a respiratory failure (37.5%). We have analyzed the contributing factors, symptoms, diagnosis, treatment and results. RESULTS: All patients presented episodes of shock with treatment of drugs. Five patients have conventional ventilation (62.5%) while three have high frequency oscillatory ventilation (37.5%). There were not significant differences in the ventilator parameters of both groups (PMA, PIP, PEEP). Three patients were supported by ECMO when they developed necrotizing tracheobronchitis. The treatment was bronchoscopic removal of necrotic tissue. There was not any complication after the procedure. A patient suffered a stenosis in the left main bronchus. Three patients have died during follow-up for different causes. The time of pursuit is of 10.33 +/- 7.61 months. CONCLUSIONS: Necrotizing tracheobronchitis may be increasing in the Neonatal Intensive Care Units, due to a bigger survival of patient with serious respiratory failure and shock. Hypotension and shock seems to be a major contributing factor in the development of this lesion. Bronchoscopy is necessary for treatment and survival of the patients.

Bronchitis↗
PubMed2002

[Extracorporeal membrane oxygenation: indications and recommendations on when to refer patients to a specialized unit].

Extracorporeal membrane oxygenation (ECMO) is a highly complex technique of extracorporeal support that has been available in Spain since 1997 and is now provided by three centres. This article aims to detail the guidelines and indications for neonatal and pediatric ECMO in severe cardiorespiratory failure and to provide information on when to contact the referral centres when treating patients who may need this treatment.

Extracorporeal Membrane Oxygenation↗
PubMed1999

[High-frequency oscillatory ventilation as salvage strategy in the newborn infant. Spanish multicenter study. I].

OBJECTIVE: The aim of this study was to evaluate the results of high frequency ventilation (HFV) used as a rescue strategy in newborn infants with severe lung disease who either failed conventional mechanical ventilation (CMV) or had an air block. PATIENTS AND METHODS: From April 1995 to June 1998, 241 infants with severe lung disease and managed according to a common protocol of HFV used as a rescue strategy were prospectively evaluated in the nine participating level III Spanish Neonatal Intensive Care Units. The most frequent diagnoses were respiratory distress syndrome (119), meconium aspiration (24), pneumonia (19) and congenital diaphragm hernia (18). RESULTS: Mean +/- SD gestational age and birth weight were 32.0 +/- 5.5 weeks and 1,187 +/- 1,071 g, respectively. All babies were previously manages with CMV for a mean of 59 hours. HFV was started at a mean postnatal age of 82 hrs, with a mean oxygenation index (OI) of 28.3 +/- 15.3 and an a/A DO2 of 0.10 +/- 0.08. Initial mean HFV settings were: mean airway pressure 12.8 +/- 3.4 mbar, frequency 8.3 +/- 1.4 Hz, amplitude 53 +/- 20 percent, tidal volume 2.2 +/- 0.7 ml/kg and FiO2 0.88 +/- 0.2. At two hours of HFV there was a significant increase in the mean PaO2 (from 48 to 80 mmHg), with a concomitant decrease in FiO2 (from 0.88 to 0.79), PaCO2 (from 60 to 46 mmHg) and OI (from 28 to 18). Mean a/A DO2 increased from 0.10 to 0.19; these changes remained similar thereafter. HFV was suspended after a mean of 95 hrs because of improvement in 70%, death in 19% and failure to improve the clinical condition in the remaining 19%. Intrahospital death rate was 32%. The following complications were observed: pneumothorax (10%), interstitial emphysema (4%), intraventricular hemorrhage grades III and IV (14.5%) and bronchopulmonary dysplasia (35%). CONCLUSIONS: HFV is an effective rescue strategy that improves pulmonary gas exchange within two hours of its initiation.

Female↗
PubMed1999

[Extracorporeal respiratory assistance (ECRA): initial experiences in Spain].

UNLABELLED: The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorporeal with flow tidal and veno-venous cannula described by Chevalier et al. in 1990. We present our clinical experience so much with AREC in system veno-venous flow tidal as veno-arterial. From october of 1997 until the present time we have treated three patients by means AREC, in two patients with veno-venous system and in one veno-arterial. In all the cases bomb Collin-Cardio has been used with bladder for flow tidal and membrane of oxygenation of 0.8 m2, being inserted a system of alternative clamp of the branches of the circuit. The system AREC has been used in two patients with congenial diaphragmatic hernia, right in a case and left in the other one. The gestational age was of 38 and 36 weeks with a weight of 3,200 and 2,900 grams. Both patients were remitted from other centers by failure of the conventional treatment. In both cases the indication of AREC was the sharp deterioration of the general state with failure of the conservative treatment, being the previous oxygenation index of 109 and 112. The third patient precised veno-arterial AREC for ventricular failure during the correction of the congenital heart disease, this patient was 5 month old and the weight was 5,000 grams. The duration of AREC in the cases of congenital diaphragmatic hernia was of 14 and 10 days. In a patient the diaphragmatic hernia was corrected at the 55 hours of being in AREC. In the second case the hernia had been surgical corrected in another center. The exit of AREC in both cases carries out after a discreet improvement of the lung function. Both patients died at the 24 and 48 hours of the decannulation for cerebral hemorrhage and respiratory failure. The third patient stayed stable in veno-arterial AREC during 4 days, with hemodynamic support of 130 ml/kg/min, retiring the support to present absence of cerebral activity. CONCLUSIONS: With the derived limitations of the extreme severity of the treated cases and the current phase of beginning of the AREC team, we think that it is a useful and available technique in our country, for the handling of patient with cardiorespiratory failure while waiting for improvement of their base pathology.

Age Factors↗
PubMed1999

[Extracorporeal membrane oxygenation, ECMO. Experience with the first 22 cases].

OBJECTIVE: Extracorporal membrane oxygenation (ECMO) is an alternative to cases of respiratory or cardiopulmonary insufficiency when conventional therapy has failed. We present the first 22 patients treated with ECMO at the neonatology unit of the "Gregorio Marañon" Hospital. PATIENTS AND METHODS: From October 1997 until September 1999, 22 patients were treated with ECMO. In 8 of them ECMO was necessary because of respiratory insufficiency without response to conventional treatment (r-ECMO) and a veno-venous tidal flow system was used. In 14 patients, cardiac ECMO was necessary in the veno-arterial modality because of ventricular failure after extracorporal circulatory assistance during cardiovascular surgery. RESULTS: The 8 patients of the respiratory ECMO group had a mean previous oxygenation index of 89 +/- 36.6 (50-150). The mean duration of ECMO was 7.8 +/- 6.5 (1-16) days and the age at the beginning of ECMO ranged between 1 and 151 days. The most frequent indications in this group were congenital diaphragmatic hernia in three cases, meconium aspiration syndrome in 2 cases and 1 case each of septic shock, idiopathic pulmonary hypertension and air leak. The cannula was removed in 5/8 patients due to recovery and 5/8 survived. The 14 patients of the cardiac ECMO group needed veno-arterial ECMO because of severe ventricular failure. Eight out of fourteen were decannulated after improvement. In 5/14 there was multiorgan failure or bad neurological prognosis resulting in death while on ECMO. In 1 out of 14 patients removal of the cannula was impossible because of cardiac insufficiency. The mean age at the beginning of ECMO was 54 (3-178) days. The mean weight at ECMO was 3209 +/- 739 (2700-5000) gr and the mean duration of ECMO was 6 (1-15) days. CONCLUSIONS: ECMO is an effective treatment in rescuing critical patients when conventional treatment fails. Meconium aspiration syndrome is the pathology with the best prognosis on ECMO. Cardiac ECMO represents a complex group of patients in which ECMO is the only treatment and which may result in recovery in 40% of the patients.

Cardiac Output, Low↗
PubMed1998

[Secondary effects of prostaglandin E1 on the management of hypoplastic left heart syndrome while waiting for heart transplantation].

OBJECTIVE: Newborns with hypoplastic left heart syndrome (HLHS) included in the heart transplant program depend on continuous prostaglandin E1 (PGE1) perfusion for a prolonged period of time, which can result in various side effects. The objective of this study was to analyze the side effects derived from the use of PGE1 in newborns with HLHS who are awaiting heart transplantation. PATIENTS AND METHODS: Fifteen newborns with HLHS included in a cardiac transplant program between January 1993 and August 1996 were studied. All received continuous endovenous perfusion of PGE1 from the time of diagnosis of the cardiopathy. RESULTS: Thirteen patients were transplanted, with 6 dying in the operating room. Seven survived. Two patients died while waiting for a transplant. All presented short term side effects derived from the continuous perfusion of PGE1, including a slight fever and irritability. However, none of them presented apnea pauses. Cortical hyperostosis and anthral hyperplasia were observed in 13 (83.3%) and 12 (80%) cases, respectively, but in all transplanted cases regression of the anthral hyperplasia was seen after 6 months and regression of the cortical hyperostosis was seen after 12 months. CONCLUSIONS: PGE1 was effective in maintaining the permeability of the ductus arteriosus. The side effects derived from the treatment were well tolerated. The appearance of cortical hyperostosis and anthral hyperplasia is related to the duration of the perfusion and these disappear in the weeks following the suspension of PGE1 treatment.

Alprostadil↗
PubMed1996

[Oxygen transport and consumption and oxygen saturation in the right atrium in an experimental model of neonatal septic shock].

UNLABELLED: Mixed venous oxygen saturation monitoring is useful to know about the balance of oxygen supply and consumption in patient with shock as well as a form of assessing the effects of different therapeutic maneuvers. Because of newborn peculiarities this measurement is difficult and therefore, the monitoring of the shock state is limited. OBJECTIVES: To investigate the validity of central venous oxygen saturation at right atria as a reflection of mixed venous oxygen saturation in an experimental model of neonatal sepsis. METHODS: In six newborn piglets septic shock was induced by 180 minutes continuous infusion of Group B Streptococcus. Blood samples were obtained from aortic and pulmonary arteries and from right atrium at baseline and at 30-minutes intervals after the bacterial infusion was begun. Changes in arterial pressures, vascular resistances, cardiac index, oxygen delivery and consumption and the oxygen extraction index were also analyzed. RESULTS: Group B Streptococcus infusion induced significant decreases versus baseline situation of both, oxygen delivery and oxygen tissular extraction index, without changes in oxygen consumption, at 30 minutes of bacterial infusion, with a significant correlation between mixed venous and central venous oxygen saturations. Mixed venous oxygen saturation significantly correlates with right atrium oxygen saturation, r2 = 0,88, along all the period of study. CONCLUSIONS: Mixed venous oxygen saturation is a useful measurement of the oxygen delivery and consumption state in the critically ill newborn infant, and central venous oxygen saturation at the right atrium can be a sure, efficient and easy alternative for the neonatal patient.

Animals↗