Invasive ventilation at the boundary of viability: A respiratory pathophysiology study of infants born between 22 and 24 weeks of gestation.

Autor: Dassios T; Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Paediatrics, University of Patras, Patras, Greece. Electronic address: theodore.dassios@kcl.ac.uk., Sindelar R; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Williams E; Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK., Kaltsogianni O; Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK., Greenough A; Women and Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Jazyk: angličtina
Zdroj: Respiratory physiology & neurobiology [Respir Physiol Neurobiol] 2025 Jan; Vol. 331, pp. 104339. Date of Electronic Publication: 2024 Sep 03.
DOI: 10.1016/j.resp.2024.104339
Abstrakt: Background: Invasive ventilation of infants born before 24 weeks of gestation is critical for survival and long-term respiratory outcomes, but currently there is a lack of evidence to guide respiratory management. We aimed to compare respiratory mechanics and gas exchange in ventilated extremely preterm infants born before and after 24 weeks of gestation.
Methods: Secondary analysis of two prospective observational cohort studies, comparing respiratory mechanics and indices of gas exchange in ventilated infants born at 22-24 weeks of gestation (N=14) compared to infants born at 25-27 weeks (N=37). The ventilation/perfusion ratio (V A /Q), intrapulmonary shunt, alveolar dead space (V Dalv ) and adjusted alveolar surface area (S A ) were measured in infants born at the Neonatal Unit of King's College Hospital NHS Foundation Trust, London, UK.
Results: Compared to infants of 25-27 weeks, infants of 22-24 weeks had higher median (IQR) intrapulmonary shunt [18 (4 - 29) % vs 8 (2 - 12) %, p=0.044] and higher V Dalv [0.9 (0.6 - 1.4) vs 0.6 (0.5 - 0.7) ml/kg, p=0.036], but did not differ in V A /Q. Compared to infants of 25-27 weeks, the infants of 22-24 weeks had a lower adjusted S A [509 (322- 687) vs 706 (564 - 800) cm 2 , p=0.044]. The infants in the two groups did not differ in any of the indices of respiratory mechanics.
Conclusion: Ventilated infants born before 24 completed weeks of gestation exhibit abnormal gas exchange, with higher alveolar dead space and intrapulmonary shunt and a decreased alveolar surface area compared to extreme preterms born after 24 weeks of gestation.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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