Ali Nabeel, Claure Nelson, Alegria Ximena, D'Ugard Carmen, Organero Roberto, Bancalari Eduardo
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
Pediatr Pulmonol. 2007 Aug;42(8):704-10. doi: 10.1002/ppul.20641.
Nasal continuous positive airway pressure (NCPAP) is used to provide support to non-intubated infants, but it often fails. Pressure support ventilation (PSV) is a mode of synchronized ventilation that can supplement the spontaneous breathing effort, but it is unknown if it is effective in non-intubated very low birth weight (VLBW) infants.
To compare the acute physiological effects of non-invasive PSV (NI-PSV) versus NCPAP on tidal volume (V(T)), minute ventilation (V(E)), gas exchange, breathing effort, and chest wall distortion in VLBW infants.
Stable preterm infants of birth weight less 1,250 g were studied during consecutive 2 hr periods of NCPAP and NI-PSV in random sequence. VT, V(E), and thoraco-abdominal synchrony were measured using respiratory inductance plethysmography. Breathing effort was measured by esophageal manometry. Gas exchange was measured by pulse oximetry and transcutaneous PCO2.
Fifteen infants of birth weight (mean +/- SD) 808 +/- 201 g and 25.9 +/- 1.8 weeks gestational age were studied while on NCPAP 5.3 +/- 0.6 cm H2O and on NI-PSV with 7.9 +/- 1.3 cm H2O above NCPAP of pressure support. There were no differences in VT, V(E), PCO2 or hypoxemia episodes. Peak and minute inspiratory effort were significantly reduced in NI-PSV mode as compared to NCPAP. There was a significant reduction in indices of chest wall asynchrony in NI-PSV mode.
When compared to NCPAP, NI-PSV did not increase minute ventilation, but it effectively unloaded the patient's respiratory pump as indicated by a lower inspiratory effort and reduced chest wall distortion.
鼻持续气道正压通气（NCPAP）用于为未插管婴儿提供支持，但它常常失败。压力支持通气（PSV）是一种同步通气模式，可补充自主呼吸努力，但对于未插管的极低出生体重（VLBW）婴儿是否有效尚不清楚。
比较无创PSV（NI-PSV）与NCPAP对VLBW婴儿潮气量（V(T)）、分钟通气量（V(E)）、气体交换、呼吸努力和胸壁变形的急性生理影响。
对出生体重小于1250g的稳定早产儿在连续2小时的NCPAP和NI-PSV期间按随机顺序进行研究。使用呼吸感应体积描记法测量V(T)、V(E)和胸腹同步性。通过食管测压法测量呼吸努力。通过脉搏血氧饱和度测定法和经皮PCO2测量气体交换。
对15名出生体重（均值±标准差）为808±201g、胎龄为25.9±1.8周 的婴儿进行了研究，研究时他们接受5.3±0.6cm H2O的NCPAP以及比NCPAP压力支持高7.9±1.3cm H2O的NI-PSV。V(T)、V(E)、PCO2或低氧血症发作方面没有差异。与NCPAP相比，NI-PSV模式下的吸气峰值和分钟努力显著降低。NI-PSV模式下胸壁不同步指数显著降低。
与NCPAP相比，NI-PSV并未增加分钟通气量，但如较低的吸气努力和胸壁变形减少所示，它有效地减轻了患者的呼吸泵负荷。
