Neonatal Unit, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Avenida Marítima del Sur S/N, 35016, Las Palmas de Gran Canaria, Spain.
Informática de sistemas (Computer Systems), Madrid, Spain.
J Perinatol. 2018 Sep;38(9):1235-1241. doi: 10.1038/s41372-018-0152-5. Epub 2018 Jun 18.
To characterize the neural breathing pattern in preterm infants supported with non-invasive neurally adjusted ventilatory assist (NIV-NAVA).
Single-center prospective observational study. The electrical activity of the diaphragm (EAdi) was periodically recorded in 30-second series with the Edi catheter and the Servo-n software (Maquet, Solna, Sweden) in preterm infants supported with NIV-NAVA. The EAdi, EAdi, EAdi, EAdi, neural inspiratory, and expiratory times (nTi and nTe) and the neural respiratory rate (nRR) were calculated. EAdi curves were generated by Excel for visual examination and classified according to the predominant pattern.
291 observations were analyzed in 19 patients with a mean GA of 27.3 weeks (range 24-36 weeks), birth weight 1028 g (510-2945 g), and a median (IQR) postnatal age of 18 days (4-27 days). The distribution of respiratory patterns was phasic without tonic activity 61.9%, phasic with basal tonic activity 18.6, tonic burst 3.8%, central apnea 7.9%, and mixed pattern 7.9%. In addition, 12% of the records showed apneas of >10 seconds, and 50.2% one or more "sighs", defined as breaths with an EAdi and/or nTi greater than twice the average EAdi and/or nTi of the recording. Neural times were measurable in 252 observations. The nTi was, median (IQR): 279 ms (253-285 ms), the nTe 764 ms (642-925 ms), and the nRR 63 bpm (51-70), with a great intra and inter-subjects variability.
The neural breathing patterns in preterm infants supported with NIV-NAVA are quite variable and are characterized by the presence of significant tonic activity. Central apneas and sighs are common in this group of patients. The nTi seems to be shorter than the mechanical Ti commonly used in assisted ventilation.
描述采用无创神经调节通气辅助（NIV-NAVA）支持的早产儿的神经呼吸模式特征。
单中心前瞻性观察研究。采用 Edi 导管和 Servo-n 软件（瑞典索纳 Maquet），在采用 NIV-NAVA 支持的早产儿中，每隔 30 秒记录一次膈肌电活动（EAdi）的系列记录。计算 EAdi、EAdi、EAdi、EAdi、神经吸气和呼气时间（nTi 和 nTe）和神经呼吸频率（nRR）。使用 Excel 生成 EAdi 曲线进行直观检查，并根据主要模式进行分类。
19 例患儿共 291 次观察，平均胎龄 27.3 周（范围 24-36 周），出生体重 1028 g（510-2945 g），中位（IQR）出生后年龄 18 天（4-27 天）。呼吸模式分布为无紧张活动的阶段性占 61.9%，有基础紧张活动的阶段性占 18.6%，紧张爆发性占 3.8%，中枢性呼吸暂停占 7.9%，混合模式占 7.9%。此外，12%的记录显示 >10 秒的呼吸暂停，50.2%的记录显示一次或多次“叹息”，定义为 EAdi 和/或 nTi 大于记录平均 EAdi 和/或 nTi 的两倍。252 次观察中可测量神经时间。nTi 中位数（IQR）：279 ms（253-285 ms），nTe 764 ms（642-925 ms），nRR 63 bpm（51-70），个体间和个体内差异很大。
采用 NIV-NAVA 支持的早产儿的神经呼吸模式变化较大，其特征是存在明显的紧张活动。中枢性呼吸暂停和叹息在该组患者中很常见。nTi 似乎比辅助通气中常用的机械 Ti 短。
