Kuypers Kristel L A M, Willemsen Lieve A, Cramer Sophie J E, Kashyap Aidan J, Drevhammar Thomas, Hooper Stuart B, Te Pas Arjan B
Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands.
The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia.
Front Pediatr. 2022 Mar 17;10:817010. doi: 10.3389/fped.2022.817010. eCollection 2022.
The resistance created by the PEEP-valve of a T-piece resuscitator is bias gas flow dependent and might affect breathing in preterm infants. In this study we investigated the effect of a higher bias gas flow on the imposed inspiratory and expiratory T-piece resistance and expiratory breaking manoeuvres (EBM) in preterm infants during spontaneous breathing on CPAP at birth.
In a retrospective pre-post implementation study of preterm infants <32 weeks gestation, who were stabilised with a T-piece resuscitator, a bias gas flow of 12 L/min was compared to 8 L/min. All spontaneous breaths on CPAP within the first 10 min of starting respiratory support were analysed on a breath-by-breath basis to determine the breathing pattern of each breath and to calculate the imposed inspiratory and expiratory T-piece resistance (Ri, Re), flow rates and tidal volume.
In total, 54 infants were included (bias gas flow 12 L/min: = 27, 8 L/min: = 27) with a median GA of 29 (28-30) and 28 (25-30), respectively ( = 0.182). Ri and Re were significantly lower in the 12 L/min compared to 8 L/min bias flow group [Ri: 29.6 (26.1-33.6) vs. 46.4 (43.0-54.1) cm HO/L/s, < 0.001; Re: 32.0 (30.0-35.1) vs. 48.0 (46.3-53.9) cm HO/L/s, < 0.001], while the incidence of EBM [77% (53-88) vs. 77% (58-90), = 0.586] was similar.
During stabilisation of preterm infants at birth with a T-piece resuscitator, the use of a higher bias gas flow reduced both the imposed inspiratory and expiratory T-piece resistance for the infant, but this did not influence the incidence of EBMs.
T形管复苏器的呼气末正压（PEEP）阀产生的阻力取决于偏流气体流量，可能会影响早产儿的呼吸。在本研究中，我们调查了较高的偏流气体流量对出生时在持续气道正压通气（CPAP）下自主呼吸的早产儿施加的吸气和呼气T形管阻力以及呼气末阻断动作（EBM）的影响。
在一项对孕周<32周、使用T形管复苏器稳定病情的早产儿进行的回顾性实施前后研究中，将12L/min的偏流气体流量与8L/min进行了比较。在开始呼吸支持的前10分钟内，对CPAP下的所有自主呼吸进行逐次呼吸分析，以确定每次呼吸的呼吸模式，并计算施加的吸气和呼气T形管阻力（Ri、Re）、流速和潮气量。
总共纳入了54例婴儿（偏流气体流量12L/min：n = 27，8L/min：n = 27），中位胎龄分别为29（28 - 30）和28（25 - 30）（P = 0.182）。与8L/min偏流组相比，12L/min组的Ri和Re显著更低[Ri：29.6（26.1 - 33.6）对46.4（43.0 - 54.1）cmH₂O/L/s，P < 0.001；Re：32.0（30.0 - 35.1）对48.0（46.3 - 53.9）cmH₂O/L/s，P < 0.001]，而EBM的发生率相似[77%（53 - 88）对77%（58 - 90），P = 0.586]。
在使用T形管复苏器对早产儿出生时进行病情稳定时，使用较高的偏流气体流量可降低婴儿施加的吸气和呼气T形管阻力，但这并不影响EBM的发生率。
