Lung volume changes during apnoeas in preterm infants.

Autor: Gaertner VD; Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland vincent.gaertner@usz.ch., Waldmann AD; Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany., Davis PG; Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.; The University of Melbourne, Melbourne, Victoria, Australia.; Murdoch Children's Research Institute, Melbourne, Victoria, Australia., Bassler D; Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland., Springer L; Department of Neonatology, University Children's Hospital, Tübingen, Germany., Tingay DG; The University of Melbourne, Melbourne, Victoria, Australia.; Murdoch Children's Research Institute, Melbourne, Victoria, Australia.; Department of Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia., Rüegger CM; Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland.
Jazyk: angličtina
Zdroj: Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2023 Mar; Vol. 108 (2), pp. 170-175. Date of Electronic Publication: 2022 Aug 29.
DOI: 10.1136/archdischild-2022-324282
Abstrakt: Objective: Mechanisms of non-invasive high-frequency oscillatory ventilation (nHFOV) in preterm infants are unclear. We aimed to compare lung volume changes during apnoeas in preterm infants on nHFOV and nasal continuous positive airway pressure (nCPAP).
Methods: Analysis of electrical impedance tomography (EIT) data from a randomised crossover trial comparing nHFOV with nCPAP in preterm infants at 26-34 weeks postmenstrual age. EIT data were screened by two reviewers to identify apnoeas ≥10 s. End-expiratory lung impedance (EELI) and tidal volumes (V T ) were calculated before and after apnoeas. Oxygen saturation (SpO 2 ) and heart rate (HR) were extracted for 60 s after apnoeas.
Results: In 30 preterm infants, 213 apnoeas were identified. During apnoeas, oscillatory volumes were detectable during nHFOV. EELI decreased significantly during apnoeas (∆EELI nCPAP: -8.0 (-11.9 to -4.1) AU/kg, p<0.001; ∆EELI nHFOV: -3.4 (-6.5 to -0.3), p=0.03) but recovered over the first five breaths after apnoeas. Compared with before apnoeas, V T was increased for the first breath after apnoeas during nCPAP (∆V T : 7.5 (3.1 to 11.2) AU/kg, p=0.001). Falls in SpO 2 and HR after apnoeas were greater during nCPAP than nHFOV (mean difference (95% CI): SpO 2 : 3.6% (2.7 to 4.6), p<0.001; HR: 15.9 bpm (13.4 to 18.5), p<0.001).
Conclusion: Apnoeas were characterised by a significant decrease in EELI which was regained over the first breaths after apnoeas, partly mediated by a larger V T . Apnoeas were followed by a considerable drop in SpO 2 and HR, particularly during nCPAP, leading to longer episodes of hypoxemia during nCPAP. Transmitted oscillations during nHFOV may explain these benefits.
Trial Registration Number: ACTRN12616001516471.
Competing Interests: Competing interests: VDG and CMR declare that they received an EIT monitor free of charge for a different research project by SenTec AG. All other authors declare that they have no conflict of interest.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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