Division of Neonatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Division of Neonatology, Department of Statistics Institute for Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Am J Perinatol. 2019 Nov;36(13):1368-1376. doi: 10.1055/s-0038-1676828. Epub 2019 Jan 8.
To investigate if the use of a visible respiratory function monitor (RFM) to use lower tidal volumes (Vts) during positive pressure ventilation (PPV) in the delivery room (DR) reduces the need of surfactant administration and invasive mechanical ventilation during the first 72 hours after birth of preterm infants <32 weeks' gestational age (GA).
Infants <32 weeks' GA ( = 106) requiring noninvasive PPV were monitored with a RFM at birth and randomized to visible ( = 54) or masked ( = 52) display on RFM. Pulmonary data were recorded during the first 10 minutes after birth. Secondary analysis stratified patients by GA (<28, 28-29, or ≥30 weeks).
Median expiratory Vts during inflations were greater in the masked group (7 mL/kg) than in the visible group (5.8 mL/kg; = 0.001) same as peak inflation pressure (PIP) administered (21.5 vs. 19.7 cmHO; < 0.001). Consequently, minute volumes were greater in the masked group (256 vs. 214 mL/kg/min; < 0.001), with no differences in respiratory rate. These differences were higher in those <30 weeks' GA. There was no difference in the need of surfactant administration or intubation during the first 72 hours of age.
Using a RFM in the DR prevents the use of large Vt and PIP during respiratory support inflations, mostly in the more immature newborn infants, but with no other short-term benefits.
研究在产房（DR）使用正压通气（PPV）时使用可视呼吸功能监测仪（RFM）是否可以降低小于 32 周胎龄（GA）的早产儿出生后 72 小时内需要使用表面活性剂和有创机械通气的几率。
需要无侵入性 PPV 的小于 32 周 GA（ = 106）的婴儿在出生时使用 RFM 进行监测，并随机分为可视（ = 54）或屏蔽（ = 52）RFM 显示。在出生后 10 分钟内记录肺部数据。对患者按 GA（<28、28-29 或≥30 周）进行二次分析分层。
在屏蔽组（7 mL/kg）中，呼气末 Vt 在充气过程中大于可见组（5.8 mL/kg； = 0.001），同样的峰值充气压力（PIP）也更大（21.5 与 19.7 cmHO； < 0.001）。因此，屏蔽组的分钟通气量更大（256 与 214 mL/kg/min； < 0.001），而呼吸频率没有差异。这些差异在 GA 小于 30 周的婴儿中更高。在出生后 72 小时内，需要使用表面活性剂或插管的情况没有差异。
在 DR 使用 RFM 可以防止在呼吸支持充气过程中使用大的 Vt 和 PIP，尤其是在更不成熟的新生儿中，但没有其他短期益处。
