tailieunhanh - Anaesthesia, Pain, Intensive Care and Emergency - Part 9

Trong một nghiên cứu gần đây, Kramlin et al. đánh giá xuyên qua SaO2 trong 175 "khỏe mạnh" trẻ sơ sinh (tuổi thai 38 3 tuần, cân nặng lúc sinh 2953 865) trong 5 phút đầu tiên của cuộc sống sau khi sinh [12]. 1 phút của cuộc sống trung bình (khoảng tứ phân vị) trancutaneous SaO2 giá trị là 63% (53-68%), xác nhận rằng oxy hóa lâm sàng (màu hồng) không phải là hữu ích cho việc đánh giá ban đầu của bệnh nhân. | Resuscitation of the newborn 379 Initial evaluation International guidelines in 2000 included five questions Term gestation Amniotic fluid clear Breathing or crying Good muscle tone Pink for the initial evaluation of each neonate 2-4 . These questions had to be asked within the first 30 s of each infant s life and the answers determined whether the neonate would receive routine or intensive care. In the international guidelines issued in 2005 5 the colour of the patient pink is not considered in this phase. In a recent study Kramlin et al. evaluated transcutaneous SaO2 in 175 healthy neonates gestational age 38 3 weeks birth weight 2 953 865 during the first 5 min of postnatal life 12 . At 1 min of life the median interquartile range trancutaneous SaO2 values were 63 53-68 confirming that clinical oxygenation pink is not useful for the initial evaluation of the patient. Meconium aspiration syndrome Meconium aspiration syndrome MAS is frequently encountered in the delivery room 2-5 . In the presence of meconium-stained infants the original guidelines suggested performing a suction of the nose mouth and posterior pharynx before delivery of the shoulders b direct laryngoscopy immediately after birth for suctioning of residual meconium from the hypopharynx and c intubation suc-tion of the trachea 2-4 . However previous studies demonstrated that tracheal suctioning of the vigorous infant with meconium-stained fluid did not improve outcome and could cause complications 13 . The 2000 guidelines stated that intubation of the trachea in meconium-stained infants must be limited to patients with absent or depressed respirations decreased muscle tone or heart rate 100 bpm 2-4 . A recent randomised multicentre study demonstrated that the suction of mouth nose and posterior pharynx before the delivery of the infant s shoulders did not change the incidence of MAS relative risk CI 14 . Based on this study the international guidelines of 2005 No longer advise routine .