Is room air best for neonatal resuscitation?

Recent evidence suggests equivalent, and possibly superior, outcomes when neonatal resuscitation is initiated with room air.

Evidence of harm from oxygen therapy includes oxidative damage, as well as a possible association with increased rates of childhood malignancy.

In 2010, the American Heart Association and the European Resuscitation Council recommend initial resuscitation with air rather than oxygen.

The need for supplemental oxygen should be guided by a pulse oximeter attached to the right upper extremity (preductal). Blended air and oxygen should only be used if there is no improvement in oxygenation.

Dawson et al. used a prospective cohort of 468 term and preterm infants to create reference ranges (3rd to 97th percentiles) for oxygen saturation measurements in the first 10 minutes of life. It is important to note that in term infants, it takes approximately 8 minutes to reach an oxygen saturation 90%, and slightly longer in preterm infants.

The table below shows targeted oxygen saturation values, by time of delivery, as recommended by the updated American Heart Association.

Time after birth	Targeted preductal SpO2 after birth
1 min	60%-65%
2 min	65%-70%
3 min	70%-75%
4 min	75%-80%
5 min	80%-85%
10 min	85%-90%

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The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

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