Synchronized Inflations Generate Greater Gravity-Dependent Lung Ventilation in Neonates.

Autor: Dowse G; Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia., Perkins E; Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Neonatology, The Royal Children's Hospital, Parkville, Australia., Thomson J; Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia., Schinckel N; Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia., Pereira-Fantini P; Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia., Tingay D; Neonatal Research, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Department of Neonatology, The Royal Children's Hospital, Parkville, Australia. Electronic address: david.tingay@rch.org.au.
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2021 Jan; Vol. 228, pp. 24-30.e10. Date of Electronic Publication: 2020 Aug 19.
DOI: 10.1016/j.jpeds.2020.08.043
Abstrakt: Objective: To describe the regional distribution patterns of tidal ventilation within the lung during mechanical ventilation that is synchronous or asynchronous with an infant's own breathing effort.
Study Design: Intubated infants receiving synchronized mechanical ventilation at The Royal Children's Hospital neonatal intensive care unit were studied. During four 10-minute periods of routine care, regional distribution of tidal volume (V T ; electrical impedance tomography), delivered pressure, and airway flow (Florian Respiratory Monitor) were measured for every inflation. Post hoc, each inflation was then classified as synchronous or asynchronous from video data of the ventilator screen, and the distribution of absolute V T and delivered ventilation characteristics determined.
Results: In total, 2749 inflations (2462 synchronous) were analyzed in 19 infants; mean (SD) age 28 (30) days, gestational age 35 (5) weeks. Synchronous inflations were associated with a shorter respiratory cycle (P = .004) and more homogenous V T (center of ventilation) along the right (0%) to left (100%) lung plane; 45.3 (8.6)% vs 48.8 (9.4)% (uniform ventilation 46%). The gravity-dependent center of ventilation was a mean (95% CI) 2.1 (-0.5, 4.6)% toward the dependent lung during synchronous inflations. Tidal ventilation relative to anatomical lung size was more homogenous during synchronized inflations in the dependent lung.
Conclusions: Synchronous mechanical ventilator lung inflations generate more gravity-dependent lung ventilation and more uniform right-to-left ventilation than asynchronous inflations.
(Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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