Song Sijie, Zhu Yefang, Li Jie, Wang Qi, Gong Hua, Zhong Xiaoyun, Wu Yan
Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China.
Front Pediatr. 2023 Jan 11;10:1007632. doi: 10.3389/fped.2022.1007632. eCollection 2022.
Although nasal continuous positive airway pressure (nCPAP) is recommended in delivery room (DR) management for preterm infants, the effect of delivering nCPAP at 6-8 cmHO is not satisfactory. Therefore, we conducted this retrospective cohort study to compare the effects of individualized dynamic positive end-expiratory pressure (dynPEEP) vs. positive pressure ventilation (PPV) in the DR on clinical outcomes.
Preterm infants with a gestational age (GA) less than 30 weeks who received PPV (peak inspiratory pressure, PIP/PEEP 15-25/6-8 cmHO) from August 2018 to July 2020 were included as Cohort 1 (PPV group, = 55), and those who received dynPEEP (nCPAP 8-15 cmHO) from June 2020 to April 2022 were included as Cohort 2 (dynPEEP group, = 62). Primary outcomes included the DR intubation rate and the bronchopulmonary dysplasia (BPD) rate. The secondary outcomes included DR stabilization, transfer, admission, respiratory function, and other outcomes.
The percentage of singleton infants was higher in the PPV group (63.6%) than in the dynPEEP group (22.6%, = 0.000). The DR intubation and chest compression rates were higher in the PPV group (80.0% and 18.2%, respectively) than in the dynPEEP group (45.2%, = 0.000; 3.0%, = 0.008, respectively). The percentage of patients with 5-min Apgar scores < 5 was higher in the PPV group (9.1%) than in the dynPEEP group (0%, = 0.016). The partial pressure of carbon dioxide was lower in the PPV group (49.77 ± 11.28) than in the dynPEEP group (56.44 ± 13.17, = 0.004), and lactate levels were higher in the PPV group (3.60 (2.10, 5.90)) than in the dynPEEP group (2.25 (1.38, 3.33), = 0.002). No significant differences in the BPD rate or other secondary outcomes were noted.
In this retrospective cohort study, the dynPEEP strategy reduced the need for DR intubation compared with PPV. The dynPEEP strategy is feasible and potentially represents an alternative respiratory strategy to PPV. Nevertheless, a randomized control trial is needed to evaluate the dynPEEP strategy.
尽管推荐在产房（DR）管理中对早产儿使用鼻持续气道正压通气（nCPAP），但以6 - 8 cmH₂O进行nCPAP通气的效果并不理想。因此，我们开展了这项回顾性队列研究，以比较产房内个体化动态呼气末正压通气（dynPEEP）与正压通气（PPV）对临床结局的影响。
将2018年8月至2020年7月接受PPV（吸气峰压，PIP/PEEP 15 - 25/6 - 8 cmH₂O）的孕周（GA）小于30周的早产儿纳入队列1（PPV组，n = 55），将2020年6月至2022年4月接受dynPEEP（nCPAP 8 - 15 cmH₂O）的早产儿纳入队列2（dynPEEP组，n = 62）。主要结局包括产房插管率和支气管肺发育不良（BPD）率。次要结局包括产房病情稳定、转运、入院、呼吸功能及其他结局。
PPV组单胎婴儿的比例（63.6%）高于dynPEEP组（22.6%，P = 0.000）。PPV组的产房插管率和胸外按压率（分别为80.0%和18.2%）高于dynPEEP组（分别为45.2%，P = 0.000；3.0%，P = 0.008）。PPV组5分钟阿氏评分＜5分的患者比例（
