Ngan Ashley Y, Cheung Po-Yin, Hudson-Mason Ann, O'Reilly Megan, van Os Sylvia, Kumar Manoj, Aziz Khalid, Schmölzer Georg M
Centre for the Study of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada.
Arch Dis Child Fetal Neonatal Ed. 2017 Nov;102(6):F525-F531. doi: 10.1136/archdischild-2016-312286. Epub 2017 Jun 8.
A sustained inflation (SI) provided at birth might reduce bronchopulmonary dysplasia (BPD).
This study aims to examine whether an SI-guided exhaled carbon dioxide (ECO) compared with positive pressure ventilation (PPV) alone at birth decreases BPD.
Randomised controlled trial. Infants were randomly allocated to either SI (SI group) or PPV (PPV group).
Participants of this study include infants between 23 and 32 weeks gestation with a need for PPV at birth.
Infants randomised into the SI group received an initial SI with a peak inflation pressure (PIP) of 24 cmHO over 20 s. The second SI was guided by the amount of ECO. If ECO was ≤20 mm Hg, a further SI of 20 s was delivered. If ECO was >20 mm Hg the second SI was 10 s. Infants randomised into the PPV group received mask PPV with an initial PIP of 24 cmHO.
Reduction in BPD defined as the need for respiratory support or supplemental oxygen at corrected gestational age of 36 weeks.
SI (n=76) and PPV (n=86) group had similar rates of BPD (23% vs 33%, p=0.090, not statistically significant). The duration of mechanical ventilation was significantly reduced with SI versus PPV (63 (10-246) hours versus 204 (17-562) hours, respectively (p=0.045)). No short-term harmful effects were identified from two SI lasting up to 40 s (eg, pneumothorax, intraventricular haemorrhage or patent ductus arteriosus).
Preterm infants <33 weeks gestation receiving SI at birth had lower duration of mechanical ventilation and similar incidence of BPD compared with PPV. Using ECO to guide length of SI is feasible.
NCT01739114; Results.
出生时给予持续性充气（SI）可能会降低支气管肺发育不良（BPD）的发生率。
本研究旨在探讨出生时与单纯正压通气（PPV）相比，SI引导下的呼出气二氧化碳（ECO）是否能降低BPD的发生率。
随机对照试验。婴儿被随机分配至SI组（SI组）或PPV组（PPV组）。
本研究的参与者包括妊娠23至32周、出生时需要PPV的婴儿。
随机分配至SI组的婴儿在20秒内接受初始SI，峰值充气压力（PIP）为24 cmH₂O。第二次SI由ECO量引导。如果ECO≤20 mmHg，则再进行20秒的SI。如果ECO>20 mmHg，则第二次SI为10秒。随机分配至PPV组的婴儿接受面罩PPV，初始PIP为24 cmH₂O。
BPD的降低定义为在矫正胎龄36周时需要呼吸支持或补充氧气。
SI组（n = 76）和PPV组（n = 86）的BPD发生率相似（分别为23%和33%，p = 0.090，无统计学意义）。与PPV相比，SI显著缩短了机械通气时间（分别为63（10 - 246）小时和204（17 - 562）小时，p = 0.045）。两次持续时间长达40秒的SI未发现短期有害影响（如气胸、脑室内出血或动脉导管未闭）。
与PPV相比，出生时接受SI的胎龄<33周的早产儿机械通气时间更短，BPD发生率相似。使用ECO引导SI的时长是可行的。
NCT01739114；结果
