Mendler Marc R, Maurer Miriam, Hassan Mohammad A, Huang Li, Waitz Markus, Mayer Benjamin, Hummler Helmut D
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.
Neonatology. 2015;108(1):73-80. doi: 10.1159/000381416. Epub 2015 Jun 2.
There are no evidence-based recommendations on the use of different techniques of respiratory support and chest compressions (CC) during neonatal cardiopulmonary resuscitation (CPR).
We studied the short-term effects of different ventilatory support strategies along with CC representing clinical practice on gas exchange [arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2)], hemodynamics and cerebral oxygenation. We hypothesized that in newborn piglets with cardiac arrest, use of a T-piece resuscitator (TPR) providing positive end-expiratory pressure (PEEP) improves gas exchange as measured by SaO2 during CPR as compared to using a self-inflating bag (SIB) without PEEP. Furthermore, we explored the effects of a mechanical ventilator without synchrony to CC.
Thirty newborn piglets with asystole were randomized into three groups and resuscitated for 20 min [fraction of inspired oxygen (FiO2) = 0.21 for 10 min and 1.0 thereafter]. Group 1 received ventilation using a TPR [peak inspiratory pressure (PIP)/PEEP of 20/5 cm H2O, rate 30/min] with inflations interposed between CC (3:1 ratio). Group 2 received ventilation using a SIB (PIP of 20 cm H2O without PEEP, rate 30/min) with inflations interposed between CC (3:1 ratio). Group 3 received ventilation using a mechanical ventilator (PIP/PEEP of 20/5 cm H2O, rate 30/min). CC were applied with a rate of 120/min without synchrony to inflations.
We found no significant differences in SaO2 between the three groups. However, there was a trend toward a higher SaO2 [TPR: 28.0% (22.3-40.0); SIB: 23.7% (13.4-52.3); ventilator: 44.1% (39.2-54.3); median (interquartile range)] and a lower PaCO2 [TPR: 95.6 mm Hg (82.1-113.6); SIB: 100.8 mm Hg (83.0-108.0); ventilator: 74.1 mm Hg (68.5-83.1); median (interquartile range)] in the mechanical ventilator group.
We found no significant effect on gas exchange using different respiratory support strategies during CPR.
在新生儿心肺复苏（CPR）期间，对于使用不同的呼吸支持技术和胸外按压（CC）尚无基于证据的推荐意见。
我们研究了不同通气支持策略以及代表临床实践的CC对气体交换[动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）]、血流动力学和脑氧合的短期影响。我们假设，在心脏骤停的新生仔猪中，与使用无呼气末正压（PEEP）的自动充气式气囊（SIB）相比，使用提供PEEP的T形管复苏器（TPR）进行CPR时，通过SaO2测量的气体交换得到改善。此外，我们探讨了与CC不同步的机械通气机的影响。
30只心脏停搏的新生仔猪被随机分为三组，并进行20分钟的复苏[吸入氧分数（FiO2）前10分钟为0.21，之后为1.0]。第1组使用TPR进行通气[吸气峰压（PIP）/PEEP为20/5 cmH2O，频率30次/分钟]，在CC期间进行充气（比例为3:1）。第2组使用SIB进行通气（PIP为20 cmH2O，无PEEP，频率30次/分钟），在CC期间进行充气（比例为3:1）。第3组使用机械通气机进行通气（PIP/PEEP为20/5 cmH2O，频率30次/分钟）。CC以120次/分钟的频率进行，与充气不同步。
我们发现三组之间的SaO2无显著差异。然而，机械通气机组有SaO2较高[TPR组：28.0%（22.3 - 40.0）；SIB组：23.7%（13.4 -
52.3）；机械通气机组：44.1%（39.2 - 54.3）；中位数（四分位间距）]和PaCO2较低[TPR组：95.6 mmHg（82.1 - 113.6）；SIB组：100.8 mmHg（83.0 - 108.0）；机械通气机组：74.1 mmHg（68.5 - 83.1）；中位数（四分位间距）]的趋势。
我们发现在CPR期间使用不同的呼吸支持策略对气体交换无显著影响。
