Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden.
Department of Paediatric Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden.
Acta Paediatr. 2017 Oct;106(10):1556-1563. doi: 10.1111/apa.13920. Epub 2017 Jun 16.
Asphyxiated neonates should be resuscitated with air, but it remains unclear if oxygen supplementation is needed in ineffectively ventilated newborn infants. We studied the return of spontaneous circulation (ROSC) with oxygen or air in an experimental model of inadequate ventilation.
Asphyxia was induced in 16 newborn piglets until their heart rate was <60 bpm or mean arterial pressure (MAP) <30 mmHg. During the first 10 minutes of resuscitation, they received one breath per minute of oxygen (n = 8) or air (n = 8). Tidal volume was 7.5 mL/kg. If MAP was <30 mmHg for 15 seconds, closed-chest cardiac massage (CCCM) was performed for 45 seconds. From 10 minutes onward, all piglets received normal ventilation with air. ROSC was defined as a heart rate >150 bpm, MAP >40 mmHg and no subsequent CCCM.
Before resuscitation, the median arterial pH was 6.73. At 10 minutes, no piglets in the oxygen group needed CCCM, while all did in the air group (p < 0.001). The median time to ROSC was 60 seconds with oxygen and 845 seconds with air (p < 0.001). No brain tissue hyperoxia occurred.
When ventilation was inadequate, one oxygen breath reduced time to ROSC in piglets with severe metabolic and respiratory acidosis.
窒息的新生儿应使用空气进行复苏，但对于通气不足的新生儿是否需要补充氧气仍不清楚。我们在通气不足的实验模型中研究了氧或空气复苏时自主循环恢复（ROSC）的情况。
16 只新生仔猪发生窒息，直至其心率<60 次/分或平均动脉压（MAP）<30mmHg。在复苏的前 10 分钟，他们接受每分钟 1 次的氧（n=8）或空气（n=8）通气。潮气量为 7.5mL/kg。如果 MAP 持续 15 秒<30mmHg，则进行 45 秒的闭胸心脏按摩（CCCM）。从第 10 分钟开始，所有仔猪均接受空气进行正常通气。ROSC 定义为心率>150 次/分，MAP>40mmHg，且无后续 CCCM。
在复苏前，动脉 pH 中位数为 6.73。在 10 分钟时，氧气组中没有仔猪需要 CCCM，而空气组中所有仔猪均需要（p<0.001）。用氧气恢复 ROSC 的中位数时间为 60 秒，用空气则为 845 秒（p<0.001）。未发生脑组织氧合过度。
在通气不足时，严重代谢性和呼吸性酸中毒的仔猪使用 1 次氧气呼吸可缩短 ROSC 时间。
