极低出生体重儿复苏时呼气末正压通气：一项随机对照的初步试验。

Positive end-expiratory pressure during resuscitation at birth in very-low birth weight infants: A randomized-controlled pilot trial.

机构信息

Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Pediatr Neonatol. 2018 Oct;59(5):448-454. doi: 10.1016/j.pedneo.2017.12.002. Epub 2017 Dec 9.

DOI:10.1016/j.pedneo.2017.12.002

PMID:29289490

Abstract

BACKGROUND

There is limited evidence of the effect of positive end-expiratory pressure (PEEP) during resuscitation soon after birth. Premature neonates may experience respiratory distress from surfactant insufficiency and providing PEEP after the very first breath, may improve outcomes following appropriate resuscitation. The objective of this study was to evaluate the short term respiratory outcomes after positive pressure ventilation (PPV) with PEEP in preterm infants at birth.

METHODS

A prospective randomized-controlled, pilot trial was conducted. Premature neonates ≤ 32 weeks gestational age or birth weight < 1500 g were recruited. Subjects were allocated to either PEEP of 5 cm HO (PEEP-5) or no PEEP (PEEP-0) if PPV was administered. Pre-ductal, peripheral capillary oxygen saturation (SpO) and fraction of inspired oxygen concentration (FiO) were monitored at 1, 3, 5, 10, 15, and 20 min after birth. FiO was adjusted to achieve targeted SpO using the 2010 neonatal resuscitation protocol guidelines.

RESULTS

56% (14/25; PEEP-0) and 50% (13/26; PEEP-5) infants received PPV. Mean gestational age was 30 (PEEP-0) vs 31 (PEEP-5) weeks. The mean [SD] birthweight (g) of PEEP-0 was significantly lower than PEEP-5 (1050.4 [262.7] vs 1218.8 [236.8], p = 0.02). Pre-ductal SpO FiO delivered at each time point, and rates of pneumothorax, surfactant administration and oxygen dependency at 36 weeks postmenstrual age or death was similar.

CONCLUSION

Due to the small sample size and potential bias accrued through random allocation of higher birthweight infants to the PEEP-5 group, the results did not confirm differences in outcomes between the groups, despite evidence favoring postnatal ventilation with PEEP. A further randomized, controlled clinical trial with a larger sample size is warranted to determine the utility and safety of PEEP during the resuscitation of premature infants immediately after birth.

摘要

背景

出生后不久行正压通气（PPV）时给予呼气末正压（PEEP）对早产儿复苏效果的证据有限。早产儿可能因肺表面活性物质不足而出现呼吸窘迫，在第一次呼吸后给予 PEEP 可能会改善适当复苏后的结局。本研究旨在评估出生时给予 PEEP 对早产儿行 PPV 的短期呼吸结局。

方法

进行了一项前瞻性随机对照、初步试验。纳入胎龄≤32 周或出生体重<1500g 的早产儿。如果给予 PPV，则将受试者分配至 PEEP 5cmH2O（PEEP-5）或无 PEEP（PEEP-0）。在出生后 1、3、5、10、15 和 20min 监测经导管前、外周毛细血管血氧饱和度（SpO2）和吸入氧浓度（FiO2）。根据 2010 年新生儿复苏指南调整 FiO2 以达到目标 SpO2。

结果

56%（14/25；PEEP-0）和 50%（13/26；PEEP-5）的婴儿接受了 PPV。平均胎龄（PEEP-0 为 30 周，PEEP-5 为 31 周）。PEEP-0 的平均（SD）出生体重（g）明显低于 PEEP-5（1050.4[262.7] vs 1218.8[236.8]，p=0.02）。每个时间点的经导管前 SpO2 和 FiO2 以及气胸、表面活性剂应用和 36 周龄时或死亡时氧依赖的发生率在两组间相似。