早产儿呼吸暂停期间的肺容积变化。

Lung volume changes during apnoeas in preterm infants.

作者信息

Gaertner Vincent D, Waldmann Andreas D, Davis Peter G, Bassler Dirk, Springer Laila, Tingay David Gerald, Rüegger Christoph Martin

机构信息

Newborn Research, Department of Neonatology, University Hospital and University of Zurich, Zurich, Switzerland

Department of Anesthesiology and Intensive Care Medicine, Rostock University Medical Center, Rostock, Germany.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2023 Mar;108(2):170-175. doi: 10.1136/archdischild-2022-324282. Epub 2022 Aug 29.

DOI:10.1136/archdischild-2022-324282

PMID:36038255

Abstract

OBJECTIVE

Mechanisms of non-invasive high-frequency oscillatory ventilation (nHFOV) in preterm infants are unclear. We aimed to compare lung volume changes during apnoeas in preterm infants on nHFOV and nasal continuous positive airway pressure (nCPAP).

METHODS

Analysis of electrical impedance tomography (EIT) data from a randomised crossover trial comparing nHFOV with nCPAP in preterm infants at 26-34 weeks postmenstrual age. EIT data were screened by two reviewers to identify apnoeas ≥10 s. End-expiratory lung impedance (EELI) and tidal volumes (V) were calculated before and after apnoeas. Oxygen saturation (SpO) and heart rate (HR) were extracted for 60 s after apnoeas.

RESULTS

In 30 preterm infants, 213 apnoeas were identified. During apnoeas, oscillatory volumes were detectable during nHFOV. EELI decreased significantly during apnoeas (∆EELI nCPAP: -8.0 (-11.9 to -4.1) AU/kg, p<0.001; ∆EELI nHFOV: -3.4 (-6.5 to -0.3), p=0.03) but recovered over the first five breaths after apnoeas. Compared with before apnoeas, V was increased for the first breath after apnoeas during nCPAP (∆V: 7.5 (3.1 to 11.2) AU/kg, p=0.001). Falls in SpO and HR after apnoeas were greater during nCPAP than nHFOV (mean difference (95% CI): SpO: 3.6% (2.7 to 4.6), p<0.001; HR: 15.9 bpm (13.4 to 18.5), p<0.001).

CONCLUSION

Apnoeas were characterised by a significant decrease in EELI which was regained over the first breaths after apnoeas, partly mediated by a larger V. Apnoeas were followed by a considerable drop in SpO and HR, particularly during nCPAP, leading to longer episodes of hypoxemia during nCPAP. Transmitted oscillations during nHFOV may explain these benefits.

TRIAL REGISTRATION NUMBER

ACTRN12616001516471.

摘要

目的

早产儿无创高频振荡通气（nHFOV）的机制尚不清楚。我们旨在比较接受nHFOV和经鼻持续气道正压通气（nCPAP）的早产儿呼吸暂停期间的肺容积变化。

方法

对一项随机交叉试验中的电阻抗断层扫描（EIT）数据进行分析，该试验比较了孕龄26 - 34周的早产儿使用nHFOV和nCPAP的情况。两名审阅者对EIT数据进行筛选，以识别持续时间≥10秒的呼吸暂停。计算呼吸暂停前后的呼气末肺阻抗（EELI）和潮气量（V）。呼吸暂停后60秒提取血氧饱和度（SpO）和心率（HR）。

结果

在30名早产儿中，共识别出213次呼吸暂停。在呼吸暂停期间，nHFOV时可检测到振荡容积。呼吸暂停期间EELI显著下降（nCPAP组的∆EELI：-8.0（-11.9至-4.1）AU/kg，p<0.001；nHFOV组的∆EELI：-3.4（-6.5至-0.3），p = 0.03），但在呼吸暂停后的前五次呼吸中恢复。与呼吸暂停前相比，nCPAP时呼吸暂停后第一次呼吸的V增加（∆V：7.5（3.1至11.2）AU/kg，p = 0.001）。呼吸暂停后nCPAP时SpO和HR的下降幅度大于nHFOV（平均差异（95%CI）：SpO：3.6%（2.7至4.6），p<0.001；HR：15.9次/分钟（13.4至18.5），p<0.001）。