Division of Neonatology, "V.Buzzi" Children's Hospital, ASST FBF-Sacco, Milan, Italy.
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Am J Perinatol. 2022 Dec;39(S 01):S63-S67. doi: 10.1055/s-0042-1758868. Epub 2022 Dec 5.
With this study, we evaluated the short-term effects of different modes and settings of noninvasive respiratory support on gas exchange, breathing parameters, and thoracoabdominal synchrony in preterm infants in the acute phase of moderate respiratory distress syndrome.
A feasibility crossover trial was conducted in neonates < 32 weeks' gestation on nasal continuous positive airway pressure (n-CPAP) or bilevel n-CPAP. Infants were delivered the following settings in consecutive order for 10 minutes each: • n-CPAP (5 cm HO) • bilevel n-CPAP 1 (Pres low = 5 cm HO, Pres high = 7 cm HO, T-high = 1 second, rate = 30/min) • n-CPAP (5 cm HO) • bilevel n-CPAP 2 (Pres low = 5 cm HO, Pres high = 7 cm HO, T-high = 2 second, rate = 15/min) • n-CPAP (5 cm HO). During each phase, physiologic parameters were recorded; the thoracoabdominal synchrony expressed by the phase angle () and other respiratory patterns were monitored by noncalibrated respiratory inductance plethysmography.
Fourteen preterm infants were analyzed. The mean CPAP level was significantly lower in the n-CPAP period compared with bilevel n-CPAP 1 and 2 ( = 0.03). Higher values were achieved with bilevel n-CPAP 2 (6.2 ± 0.6 vs. 5.7 ± 0.5 cm HO, respectively; < 0.05). No statistical difference in the was detected, nor between the three settings.
Our study did not show any superiority of bilevel n-CPAP over n-CPAP. However, nonsynchronized bilevel n-CPAP might be helpful when additional pressure is needed.
· There is currently a high degree of uncertainty about the superiority of one modality and setting of noninvasive respiratory over another.. · Our study confirmed that non-synchronized bilevel n-CPAP might be helpful when additional pressure is needed for recruitment.. · A T-high of 1 second could possibly be better tolerated in this population, but further research is needed..
本研究旨在评估不同模式和设置的无创性呼吸支持对急性呼吸窘迫综合征早产儿短期气体交换、呼吸参数和胸腹同步性的影响。
对胎龄<32 周的新生儿进行了一项可行性交叉试验，分别在鼻塞持续气道正压通气（n-CPAP）或双水平 n-CPAP 上进行。婴儿将连续接受以下设置，每种设置持续 10 分钟：•n-CPAP（5cmH2O）•双水平 n-CPAP1（低 Pres=5cmH2O，高 Pres=7cmH2O，T-high=1 秒，频率=30 次/分）•n-CPAP（5cmH2O）•双水平 n-CPAP2（低 Pres=5cmH2O，高 Pres=7cmH2O，T-high=2 秒，频率=15 次/分）•n-CPAP（5cmH2O）。在每个阶段，记录生理参数；通过非校准呼吸电感容积描记法监测胸腹同步性表示的相位角（）和其他呼吸模式。
分析了 14 名早产儿。n-CPAP 期间的平均 CPAP 水平明显低于双水平 n-CPAP1 和 2（=0.03）。双水平 n-CPAP2 时达到较高值（分别为 6.2±0.6cmH2O 和 5.7±0.5cmH2O；<0.05）。未检测到相位角的统计学差异，也未在这三种设置之间检测到差异。
本研究未显示双水平 n-CPAP 优于 n-CPAP。然而，当需要额外压力时，非同步双水平 n-CPAP 可能会有所帮助。
·目前，对于一种模式和设置的无创性呼吸支持是否优于另一种模式和设置，存在高度不确定性。·本研究证实，当需要额外的压力来募集时，非同步双水平 n-CPAP 可能会有所帮助。·1 秒的 T-high 可能在该人群中更容易耐受，但需要进一步研究。
