Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland
Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland.
Arch Dis Child Fetal Neonatal Ed. 2022 Sep;107(5):508-512. doi: 10.1136/archdischild-2021-322989. Epub 2021 Dec 3.
We sought to determine the effect of stimulation during positive pressure ventilation (PPV) on the number of spontaneous breaths, exhaled tidal volume (VTe), mask leak and obstruction.
Secondary analysis of a prospective, randomised trial comparing two face masks.
Single-centre delivery room study.
Newborn infants ≥34 weeks' gestation at birth.
Resuscitations were video recorded. Tactile stimulations during PPV were noted and the timing, duration and surface area of applied stimulus were recorded. Respiratory flow waveforms were evaluated to determine the number of spontaneous breaths, VTe, leak and obstruction. Variables were recorded throughout each tactile stimulation episode and compared with those recorded in the same time period immediately before stimulation.
Twenty of 40 infants received tactile stimulation during PPV and we recorded 57 stimulations during PPV. During stimulation, the number of spontaneous breaths increased (median difference (IQR): 1 breath (0-3); p<0.001) and VTe increased (0.5 mL/kg (-0.5 to 1.7), p=0.028), whereas mask leak (0% (-20 to 1), p=0.12) and percentage of obstructed inflations (0% (0-0), p=0.14) did not change, compared with the period immediately prior to stimulation. Increased duration of stimulation (p<0.001) and surface area of applied stimulus (p=0.026) were associated with a larger increase in spontaneous breaths in response to tactile stimulation.
Tactile stimulation during PPV was associated with an increase in the number of spontaneous breaths compared with immediately before stimulation without a change in mask leak and obstruction. These data inform the discussion on continuing stimulation during PPV in term infants.
Australian and New Zealand Clinical Trial Registry (ACTRN12616000768493).
我们旨在确定正压通气（PPV）期间刺激对自主呼吸次数、呼出潮气量（VTe）、面罩泄漏和阻塞的影响。
对比较两种面罩的前瞻性随机试验的二次分析。
单中心分娩室研究。
出生时胎龄≥34 周的新生儿。
复苏过程进行了录像。记录了在 PPV 期间的触觉刺激，并记录了刺激的时间、持续时间和应用刺激的表面积。评估呼吸流量波形以确定自主呼吸次数、VTe、泄漏和阻塞。在每次触觉刺激期间记录变量，并与刺激前同一时间段记录的变量进行比较。
在 40 名婴儿中有 20 名在 PPV 期间接受了触觉刺激，我们记录了 57 次 PPV 期间的刺激。在刺激期间，自主呼吸次数增加（中位数差异（IQR）：1 次呼吸（0-3）；p<0.001），VTe 增加（0.5 毫升/千克（-0.5 至 1.7）；p=0.028），而面罩泄漏（0%（-20 至 1）；p=0.12）和阻塞性充气百分比（0%（0-0）；p=0.14）与刺激前的时间段相比没有变化。刺激持续时间的增加（p<0.001）和应用刺激的表面积（p=0.026）与触觉刺激后自主呼吸次数的增加相关。
与刺激前相比，PPV 期间的触觉刺激与自主呼吸次数的增加相关，而面罩泄漏和阻塞没有变化。这些数据为讨论在足月婴儿中继续进行 PPV 期间的刺激提供了信息。
澳大利亚和新西兰临床试验注册中心（ACTRN12616000768493）。
