Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
J Pediatr. 2018 Mar;194:54-59. doi: 10.1016/j.jpeds.2017.11.008. Epub 2018 Jan 12.
To compare the respiratory effort of very preterm infants receiving positive pressure ventilation (PPV) with infants breathing on continuous positive airway pressure (CPAP), directly after birth.
Recorded resuscitations of very preterm infants receiving PPV or CPAP after birth were analyzed retrospectively. The respiratory effort (minute volume and recruitment breaths [>8 mL/kg], heart rate, oxygen saturation, and oxygen requirement were analyzed for the first 2 minutes and in the fifth minute after birth.
Respiratory effort was analyzed in 118 infants, 87 infants receiving PPV and 31 infants receiving CPAP (median gestational age, 28 weeks [IQR, 26-29] vs 29 weeks [IQR, 29-30; P < .001); birth weight, 1059 g [IQR, 795-1300] vs 1205 g [IQR, 956-1418; P = .06]). The minute volume of spontaneous breaths of infants receiving PPV was lower at 2 minutes (37 mL/kg/minute [IQR, 15-69] vs 188 mL/kg/minute [IQR, 128-297; P < .001]) and at 5 minutes (112 mL/kg/minute [IQR, 46-229] vs 205 mL/kg/minute [IQR, 174-327; P < .001]). Recruitment breaths occurred less in the PPV group at 2 minutes (0 breaths/minute [IQR, 0-1] vs 4 breaths/minute [IQR, 1-8; P < .001]) and 5 minutes (0 breaths/minute [IQR, 0-3] vs 2 breaths/minute [IQR, 0-11; P = .01). The heart rate was lower in the PPV group (94 beats/minute [IQR, 68-128] vs 124 beats/minute [IQR, 100-144; P = .02]) as was oxygen saturation (50% [IQR, 35%-66%] vs 67% [IQR, 34%-80%; P = .04]), but not different at 5 minutes (heart rate, 149 beats/minute [IQR, 131-162] vs 150 beats/minute [IQR, 132-160; P = NS]; oxygen saturation , 91% [IQR, 80%-95%] vs 92% [IQR, 89%-97%; P = NS]). The oxygen requirement was higher (at 2 minutes, 30% [IQR, 21%-53%] vs 21% [IQR, 21%-29%; P = .05]; at 5 minutes, 39% [IQR, 22%-91%] vs 22% [IQR, 21%-31%; P = .003]).
Very preterm infants breathe at birth when receiving PPV, but the respiratory effort was significantly lower when compared with infants receiving CPAP only. The reduced breathing effort observed likely justified applying PPV in most infants.
比较出生后接受正压通气（PPV）和持续气道正压通气（CPAP）的极早产儿的呼吸努力。
回顾性分析出生后接受 PPV 或 CPAP 复苏的极早产儿的记录。分析出生后第 1 分钟和第 5 分钟的呼吸努力（分钟通气量和募集呼吸[>8 mL/kg]、心率、氧饱和度和氧需求）。
共分析了 118 名婴儿的呼吸努力，其中 87 名婴儿接受 PPV，31 名婴儿接受 CPAP（中位胎龄 28 周[IQR，26-29]与 29 周[IQR，29-30；P<0.001]；出生体重 1059 g[IQR，795-1300]与 1205 g[IQR，956-1418；P=0.06]）。接受 PPV 的婴儿在第 2 分钟（37 mL/kg/min[IQR，15-69]与 188 mL/kg/min[IQR，128-297；P<0.001]）和第 5 分钟（112 mL/kg/min[IQR，46-229]与 205 mL/kg/min[IQR，174-327；P<0.001]）的自主呼吸分钟通气量较低。在第 2 分钟（0 次/分钟[IQR，0-1]与 4 次/分钟[IQR，1-8；P<0.001]）和第 5 分钟（0 次/分钟[IQR，0-3]与 2 次/分钟[IQR，0-11；P=0.01]）接受 PPV 的婴儿募集呼吸较少。PPV 组的心率较低（94 次/分钟[IQR，68-128]与 124 次/分钟[IQR，100-144；P=0.02]），氧饱和度较低（50%[IQR，35%-66%]与 67%[IQR，34%-80%；P=0.04]），但在第 5 分钟时没有差异（心率，149 次/分钟[IQR，131-162]与 150 次/分钟[IQR，132-160；P=NS]；氧饱和度，91%[IQR，80%-95%]与 92%[IQR，89%-97%；P=NS]）。氧需求较高（第 2 分钟时，30%[IQR，21%-53%]与 21%[IQR，21%-29%；P=0.05]；第 5 分钟时，39%[IQR，22%-91%]与 22%[IQR，21%-31%；P=0.003]）。
出生后接受 PPV 的极早产儿会自主呼吸，但与仅接受 CPAP 的婴儿相比，呼吸努力明显降低。观察到的呼吸努力降低可能证明在大多数婴儿中应用 PPV 是合理的。
