Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2020 Nov;105(6):605-608. doi: 10.1136/archdischild-2019-318579. Epub 2020 Mar 9.
The clinical impact of ventilation corrective steps for delivery room positive pressure ventilation (PPV) is not well studied. We aimed to characterise the performance and effect of ventilation corrective steps (MRSOPA (Mask adjustment, Reposition airway, Suction mouth and nose, Open mouth, Pressure increase and Alternative airway)) during delivery room resuscitation of preterm infants.
Prospective observational study of delivery room PPV using video and respiratory function monitor recordings.
Tertiary academic delivery hospital.
Preterm infants <32 weeks gestation.
Mean exhaled tidal volume (Vte) of PPV inflations before and after MRSOPA interventions, categorised as inadequate (<4 mL/kg); appropriate (4-8 mL/kg), or excessive (>8 mL/kg). Secondary outcomes were leak (>30%) and obstruction (Vte <1 mL/kg), and infant heart rate.
There were 41 corrective interventions in 30 infants, with a median duration of 15 (IQR 7-29) s. The most frequent intervention was a combination of Mask/Reposition and Suction/Open. Mean Vte was inadequate before 16/41 interventions and became adequate following 6/16. Mean Vte became excessive after 6/41 interventions. Mask leak, present before 13/41 interventions, was unchanged after 4 and resolved after 9. Obstruction was present before five interventions and was subsequently resolved only once. MRSOPA interventions introduced leak in two cases and led to obstruction in one case. The heart rate was <100 beats per minute before 31 interventions and rose to >100 beats per minute after 14/31 of these.
Ventilation correction interventions improve tidal volume delivery in some cases, but lead to ineffective or excessive tidal volumes in others. Mask leak and obstruction can be induced by MRSOPA manoeuvres.
产房正压通气（PPV）的通气纠正步骤的临床影响尚未得到很好的研究。我们旨在描述早产儿产房复苏期间通气纠正步骤（MRSOPA（面罩调整、气道重新定位、口鼻吸引、张口、增加压力和替代气道））的表现和效果。
使用视频和呼吸功能监测仪记录对产房 PPV 进行的前瞻性观察研究。
三级学术分娩医院。
<32 周胎龄的早产儿。
MRSOPA 干预前后 PPV 充气的平均呼气潮气量（Vte），分为不足（<4ml/kg）；适当（4-8ml/kg）或过多（>8ml/kg）。次要结果为泄漏（>30%）和阻塞（Vte <1ml/kg）以及婴儿心率。
在 30 名婴儿中进行了 41 次纠正干预，中位数持续时间为 15（IQR 7-29）s。最常见的干预措施是面罩/重新定位和吸引/张口的组合。在 16/41 次干预前，Vte 均值不足，在 6/16 次干预后变为适当。在 6/41 次干预后，Vte 均值变得过多。在 41 次干预前，面罩泄漏存在于 13/41 次干预中，在 4 次干预后无变化，在 9 次干预后得到解决。在 5 次干预前存在阻塞，此后仅解决了一次。MRSOPA 干预在 2 例中引入了泄漏，并在 1 例中导致了阻塞。在 31 次干预前，心率<100 次/分钟，在这些干预中的 14/31 次后上升至>100 次/分钟。
通气纠正干预在某些情况下可改善潮气量输送，但在其他情况下可导致无效或过多的潮气量。MRSOPA 操作可引起面罩泄漏和阻塞。
