Department of Paediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Graz, Graz, Steiermark, Austria.
Newborn Intensive Care Unit, Westmead Hospital Western Sydney LHD, Westmead, New South Wales, Australia.
BMJ Paediatr Open. 2024 Nov 5;8(1):e002948. doi: 10.1136/bmjpo-2024-002948.
Continuous positive airway pressure (CPAP) is a recommended first-line therapy for infants with respiratory distress at birth. Resuscitation devices incorporating CPAP delivery can have significantly different imposed resistances affecting airway pressure stability and work of breathing.
To compare CPAP performance of two resuscitation devices (Neopuff T-piece resuscitator and rPAP) in a neonatal lung model simulating spontaneous breathing effort at birth.
The parameters assessed were variation in delivered pressures (∆P), tidal volume (VT), inspiratory effort (model pressure respiratory muscle (PRM)) and work of breathing (WOB). Two data sequences were required with Neopuff and one with rPAP: (1) set PRM with changes in VT and (2) constant VT (preterm 6 mL, term 22 mL) with increased effort. Data were collected at CPAP settings of 5, 7 and 9 cmHO using a 1 kg preterm (Compliance: 0.5 mL/cmHO) and 3.5 kg term (1.0 mL/cmHO) model.
2298 breaths were analysed (760 rPAP, 795 Neopuff constant VT, 743 Neopuff constant PRM). With CPAP at 9 cmHO and set VT the mean ∆P (cmHO) rPAP vs Neopuff 1.1 vs 5.6 (preterm) and 1.9 vs 13.4 (term), WOB (mJ) 4.6 vs 6.1 (preterm) and 35.3 vs 44.5 (term), and with set PRM mean VT (ml) decreased to 6.2 vs 5.2 (preterm) and 22.3 vs 17.5 (term) p<0.001. Similar results were found at pressures of 5 and 7 cmHO.
rPAP had smaller pressure swings than Neopuff at all CPAP levels and was thus more pressure stable. WOB was higher with Neopuff when VT was held constant. VT reduced with Neopuff when respiratory effort was constant.
持续气道正压通气（CPAP）是治疗新生儿呼吸窘迫的一线推荐疗法。结合 CPAP 输送的复苏设备可能具有显著不同的强制阻力，影响气道压力稳定性和呼吸功。
比较两种复苏设备（新生儿复苏袋和 rPAP）在模拟出生时自主呼吸努力的新生儿肺模型中的 CPAP 性能。
评估的参数包括输送压力的变化（ΔP）、潮气量（VT）、吸气努力（模型压力呼吸肌（PRM））和呼吸功（WOB）。需要使用新生儿复苏袋进行两个数据序列，并且需要在 rPAP 上进行一个数据序列：（1）在 VT 变化时设置 PRM，（2）在增加努力时保持恒定 VT（早产儿 6ml，足月儿 22ml）。在使用 1kg 早产儿（顺应性：0.5ml/cmHO）和 3.5kg 足月儿模型时，在 CPAP 设置为 5、7 和 9cmHO 下收集数据。
分析了 2298 次呼吸（760 次 rPAP、795 次新生儿复苏袋恒定 VT、743 次新生儿复苏袋恒定 PRM）。在 CPAP 为 9cmHO 且设定 VT 时，rPAP 与新生儿复苏袋的平均ΔP（cmHO）分别为 1.1 和 5.6（早产儿）和 1.9 和 13.4（足月儿），WOB（mJ）分别为 4.6 和 6.1（早产儿）和 35.3 和 44.5（足月儿），当设定 PRM 时，平均 VT（ml）减少到 6.2 和 5.2（早产儿）和 22.3 和 17.5（足月儿）p<0.001。在 5 和 7cmHO 的压力下也得到了类似的结果。
rPAP 在所有 CPAP 水平下的压力波动都小于新生儿复苏袋，因此更具压力稳定性。当 VT 保持恒定时，新生儿复苏袋的 WOB 更高。当呼吸努力恒定时，新生儿复苏袋的 VT 减少。
