出生后第一周内极早产儿高频振荡通气期间平均气道压力与肺漏气之间的关联
Association between mean airway pressure during high-frequency oscillatory ventilation and pulmonary air leak in extremely preterm infants during the first week of life.
作者信息
Tamai Kei, Takeuchi Akihito, Nakamura Makoto, Nakamura Kazue, Matsumoto Naomi, Yorifuji Takashi, Kageyama Misao
机构信息
Division of Neonatology, NHO Okayama Medical Center, Okayama, Japan.
Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
出版信息
Front Pediatr. 2024 May 30;12:1410627. doi: 10.3389/fped.2024.1410627. eCollection 2024.
BACKGROUND
While positive pressure ventilation has been considered an important contributing factor associated with pulmonary air leaks, studies examining the association between specific ventilatory settings during acute-phase high-frequency oscillatory ventilation (HFOV) and pulmonary air leaks among extremely preterm infants are limited.
METHODS
This was a single-center retrospective cohort study conducted at an institution that primarily used HFOV after intubation in extremely preterm infants. We analyzed data from extremely preterm infants born between 2010 and 2021. The primary outcome was pulmonary air leakage during the first 7 days of life. The exposure variable was the maximum mean airway pressure (MAP) on HFOV during the first 7 days of life or before the onset of pulmonary air leaks. Maximum MAP was categorized into three groups: low (7-10 cmHO), moderate (11-12 cmHO), and high (13-15 cmHO) MAP categories. We conducted robust Poisson regression analyses after adjustment for perinatal confounders, using the low MAP category as the reference.
RESULTS
The cohort included 171 infants (low MAP, 123; moderate MAP, 27; and high MAP, 21). The median (interquartile range) gestational age and birth weight were 25.7 (24.3-26.7), 25.7 (24.9-26.9), and 25.3 (24.3-26.6) weeks and 760 (612-878), 756 (648-962), and 734 (578-922) g for infants in the low, moderate, and high MAP categories, respectively. Compared to infants in the low MAP category, those in the high MAP category had a higher incidence of pulmonary air leaks (4.1% vs. 33.3%; adjusted risk ratio, 5.4; 95% confidence interval, 1.6-18.5). In contrast, there was no clear difference in the risk of pulmonary air leaks between the moderate and low MAP categories (3.7% vs. 4.1%; adjusted risk ratio, 0.9; 95% confidence interval, 0.1-6.1).
CONCLUSION
Extremely preterm infants requiring high MAP (≥13 cmHO) in acute-phase HFOV had a higher risk of pulmonary air leak during the first 7 days of life.
背景
虽然正压通气被认为是与肺漏气相关的一个重要因素，但关于急性期高频振荡通气（HFOV）期间特定通气设置与极早产儿肺漏气之间关联的研究有限。
方法
这是一项在一家机构进行的单中心回顾性队列研究，该机构主要在极早产儿插管后使用HFOV。我们分析了2010年至2021年出生的极早产儿的数据。主要结局是出生后7天内的肺漏气情况。暴露变量是出生后7天内或肺漏气发作前HFOV时的最大平均气道压（MAP）。最大MAP分为三组：低（7 - 10 cmH₂O）、中（11 - 12 cmH₂O）和高（13 - 15 cmH₂O）MAP类别。我们在对围产期混杂因素进行调整后进行了稳健泊松回归分析，以低MAP类别作为对照。
结果
该队列包括171名婴儿（低MAP组123名、中MAP组27名、高MAP组21名）。低、中、高MAP类别婴儿的胎龄中位数（四分位间距）和出生体重分别为25.7（24.3 - 26.7）周、25.7（24.9 - 26.9）周、25.3（24.3 - 26.6）周和760（612 - 878）g、756（648 - 962）g、734（578 - 922）g。与低MAP类别婴儿相比，高MAP类别婴儿的肺漏气发生率更高（4.1%对33.3%；调整风险比，5.4；95%置信区间，1.6 - 18.5）。相比之下，中MAP和低MAP类别之间肺漏气风险无明显差异（3.7%对4.1%；调整风险比，0.9；95%置信区间，0.1 - 6.1）。
结论
在急性期HFOV中需要高MAP（≥13 cmH₂O）的极早产儿在出生后7天内发生肺漏气的风险更高。
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