Transmission of Oscillatory Volumes into the Preterm Lung during Noninvasive High-Frequency Ventilation.
| Autor: | Gaertner, Vincent D., Waldmann, Andreas D., Davis, Peter G., Bassler, Dirk, Springer, Laila, Thomson, Jessica, Tingay, David G., Rüegger, Christoph M. |
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| Předmět: |
PREMATURE labor
NONINVASIVE ventilation ELECTRICAL impedance tomography ARTIFICIAL respiration CONFIDENCE intervals RESPIRATORY distress syndrome treatment RESEARCH CONTINUOUS positive airway pressure RESEARCH methodology MEDICAL cooperation EVALUATION research COMPARATIVE studies RANDOMIZED controlled trials FORCED expiratory volume HIGH-frequency ventilation (Therapy) CROSSOVER trials STATISTICAL sampling |
| Zdroj: | American Journal of Respiratory & Critical Care Medicine; 4/15/2021, Vol. 203 Issue 8, p998-1005, 8p |
| Abstrakt: | Rationale: There is increasing evidence for a clinical benefit of noninvasive high-frequency oscillatory ventilation (nHFOV) in preterm infants. However, it is still unknown whether the generated oscillations are effectively transmitted to the alveoli.Objectives: To assess magnitude and regional distribution of oscillatory volumes (VOsc) at the lung level.Methods: In 30 prone preterm infants enrolled in a randomized crossover trial comparing nHFOV with nasal continuous positive airway pressure, electrical impedance tomography recordings were performed. During nHFOV, the smallest amplitude to achieve visible chest wall vibration was used, and the frequency was set at 8 hertz.Measurements and Main Results: Thirty consecutive breaths during artifact-free tidal ventilation were extracted for each of the 228 electrical impedance tomography recordings. After application of corresponding frequency filters, Vt and VOsc were calculated. There was a signal at 8 and 16 Hz during nHFOV, which was not detectable during nasal continuous positive airway pressure, corresponding to the set oscillatory frequency and its second harmonic. During nHFOV, the mean (SD) VOsc/Vt ratio was 0.20 (0.13). Oscillations were more likely to be transmitted to the non-gravity-dependent (mean difference [95% confidence interval], 0.041 [0.025-0.058]; P < 0.001) and right-sided lung (mean difference [95% confidence interval], 0.040 [0.019-0.061]; P < 0.001) when compared with spontaneous Vt.Conclusions: In preterm infants, VOsc during nHFOV are transmitted to the lung. Compared with the regional distribution of tidal breaths, oscillations preferentially reach the right and non-gravity-dependent lung. These data increase our understanding of the physiological processes underpinning nHFOV and may lead to further refinement of this novel technique. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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