Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Neonatology, The Royal Women's Hospital, Melbourne, Victoria, Australia.
J Pediatr. 2015 Jul;167(1):81-5.e1. doi: 10.1016/j.jpeds.2015.04.003. Epub 2015 May 6.
To compare the nasal tube with face mask as interfaces for stabilization of very preterm infants at birth by using physiological measurements of leak, obstruction, and expired tidal volumes during positive pressure ventilation (PPV).
In the delivery room, 43 infants <30 weeks gestation were allocated to receive respiratory support by nasal tube or face mask. Respiratory function, heart rate, and oxygen saturation were measured. Occurrence of obstruction, amount of leak, and tidal volumes were compared using a Mann-Whitney U test or a Fisher exact test.
The first 5 minutes after initiation of PPV were analyzed (1566 inflations in the nasal tube group and 1896 inflations in the face mask group). Spontaneous breathing coincided with PPV in 32% of nasal tube and 34% of face mask inflations. During inflations, higher leak was observed using nasal tube compared with face mask (98% [33%-100%] vs 14 [0%-39%]; P < .0001). Obstruction occurred more often (8.2% vs 1.1%; P < .0001). Expired tidal volumes were significantly lower during inflations when using nasal tube compared with face mask (0.0 [0.0-3.1] vs 9.9 [5.5-12.8] mL/kg; P < .0001) and when spontaneous breathing coincided with PPV (4.4 [2.1-8.4] vs 9.6 [5.4-15.2] mL/kg; P < .0001) but were similar during breathing on continuous positive airway pressure (4.7 [2.8-6.9] vs 4.8 [2.7-7.9] mL/kg; P > 0.05). Heart rate was not significantly different between groups, but oxygen saturation was significantly lower in the nasal tube group the first 2 minutes after start of respiratory support.
The use of a nasal tube led to large leak, more obstruction, and inadequate tidal volumes compared with face mask.
Trial registration Registered with the Dutch Trial Registry (NTR 2061) and the Australia and New Zealand Clinical Trials Register (ACTRN 12610000230055).
通过测量正压通气（PPV）期间的泄漏、阻塞和潮气容积，比较鼻管与面罩作为极早产儿出生时稳定的接口。
在产房，将 43 名<30 周的婴儿分配接受鼻管或面罩呼吸支持。测量呼吸功能、心率和血氧饱和度。使用 Mann-Whitney U 检验或 Fisher 确切检验比较阻塞、泄漏量和潮气量。
分析了开始 PPV 后的前 5 分钟（鼻管组 1566 次充气，面罩组 1896 次充气）。32%的鼻管充气和 34%的面罩充气与 PPV 同时出现自主呼吸。在充气过程中，与面罩相比，鼻管观察到更高的泄漏（98%[33%-100%]比 14%[0%-39%]；P<.0001）。阻塞更常发生（8.2%比 1.1%；P<.0001）。与面罩相比，使用鼻管时潮气容积明显较低（0.0[0.0-3.1]比 9.9[5.5-12.8]mL/kg；P<.0001），当自主呼吸与 PPV 同时发生时（4.4[2.1-8.4]比 9.6[5.4-15.2]mL/kg；P<.0001），但在持续气道正压通气时相似（4.7[2.8-6.9]比 4.8[2.7-7.9]mL/kg；P>0.05）。两组心率无显著差异，但鼻管组在开始呼吸支持后的前 2 分钟血氧饱和度明显较低。
与面罩相比，鼻管导致大量泄漏、更多阻塞和潮气量不足。
试验在荷兰试验注册中心（NTR 2061）和澳大利亚和新西兰临床试验注册中心（ACTRN 12610000230055）注册。
