Exploration of the Linkage between the A:a gradient and oxygen transfer efficiency as a measure of response to treatment with inhaled nitric oxide in a heterogenous group of newborns treated for acute hypoxic respiratory failure

Show full item record

Title: Exploration of the Linkage between the A:a gradient and oxygen transfer efficiency as a measure of response to treatment with inhaled nitric oxide in a heterogenous group of newborns treated for acute hypoxic respiratory failure
Author: Leah Michaelle Best
Abstract: Acute hypoxic respiratory failure , (AHRF ) is a severe condition associated with high morbidity and mortality rates in neonates . While much is known about the treatment for AHRF , less is understood about the types or degree of physiological shunting which occurs in this condition . Therefore , the purpose of this study was to explore the relationship between intrapulmonary and extra pulmonary shunting and oxygen transfer efficiency in the newborn treated for AHRF using inhaled nitric oxide . The aims of this study were to identify linkages between shunting and oxygenation prior to and during inhaled nitric oxide (iNO ) therapy and to determine whether gestational age is predictive of infants’ response to iNO therapy . \r \nA secondary data analysis was conducted on 74 infants who received a treatment protocol of iNO over a one -week period . A :a gradient measures were examined to determine the correlation prior to treatment for baseline measures . Infants’ data were grouped by mode of ventilation to determine whether shunt differed between groups . Infants were then grouped by responders and non responders to examined differences in the A :a gradient over the treatment period . Finally gestational age was examined as a possible predictor of response , followed by examination of other possible predictive variables . \r \nThe findings suggest there was a negative moderate relationship between the A :a gradient (r = .33 , p= .004 ) but there was no difference in the degree of shunt based on the use of high frequency vs . conventional ventilation (t = .07 , p = .944 ) . Additionally , there were significant main effects for time (F=4 .94 , p= .009 ) and groups (F=13 .74 , p= .001 ) . Although the less mature infants failed to respond twice as often , they failed to reach statistically significant levels (c2=2 .79 , df=1 , p= .095 ) . Race , ventilator type , nor early onset -sepsis was a predictor in response to iNO . In conclusion , the A :a gradient provides useful information relative to oxygen transfer efficiency and it appears useful in trending infant’s response to treatment and degree of shunt . Although the more premature infant is most likely to fail the first iNO course , many survived without serious sequelae . Therefore , gestational age should not be used for exclusion criteria when designing treatment protocols .
URI: http : / /hdl .handle .net /2152 .3 /150
Date: 2008-07-07

Citation

Exploration of the Linkage between the A:a gradient and oxygen transfer efficiency as a measure of response to treatment with inhaled nitric oxide in a heterogenous group of newborns treated for acute hypoxic respiratory failure. Doctoral dissertation, The University of Texas Medical Branch. Available electronically from http : / /hdl .handle .net /2152 .3 /150 .

Files in this item

Files Size Format View
LM_Best_dissertation_july_08.pdf 2.178Mb application/pdf View/Open

This item appears in the following Collection(s)

Show full item record

Search DSpace

Advanced Search

Browse