Oyster Woman and Child Hospital, Bengaluru, India.
Ankura Hospital for Women and Children, Hyderabad, India.
Neonatology. 2024;121(3):288-297. doi: 10.1159/000537800. Epub 2024 Mar 11.
A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes.
Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials.
This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.
很大一部分早产儿在出生后立即需要正压通气 (PPV)。PPV 可以通过面罩 (FM) 或鼻插管进行。目前的文献表明，这两种方法的效果相似。
尽管如此，FM 仍然是最常用和最佳的选择。然而，大多数可用的 FM 尺寸对于极早产儿来说太大，导致面罩泄漏和无效的 PPV。提供有效 PPV 的挑战包括呼吸驱动不足、胸廓抱怨、胸肌无力、液体清除延迟以及早产儿表面活性剂缺乏。面罩泄漏、气道阻塞、技术不佳和尺寸不合适是无效 PPV 的可纠正原因。观察胸部起伏通常用于评估 PPV 的效果。然而，其准确性存在争议。虽然呼气末 CO2 可以判断 PPV 的效果，但临床研究有限。早产儿肺的顺应性是高度动态的。T 形件上设置的充气压力在整个复苏过程中是恒定的，但肺容量和动力学随每一次呼吸而变化。这导致潮气量输送的巨大波动，并可能在早产儿中引发炎症级联反应，导致脑和肺损伤。分娩室中的呼吸功能监测有可能指导和优化分娩室复苏。然而，这受到高成本、复苏期间难以解释的复杂信息以及缺乏临床试验的限制。
这篇综述总结了早产儿 PPV 的现有文献，以及与它相关的各个方面，如病理生理学、接口、用于输送它的设备、适当的技术、新兴技术和未来方向。
