Reiss Annalena, Lauth Wanda, Wald Martin
Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, Salzburg, Austria.
Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria.
Pediatr Pulmonol. 2025 Jan;60(1):e27419. doi: 10.1002/ppul.27419. Epub 2024 Dec 2.
Many extremely small preterm infants need to be intubated and mechanically ventilated during their intensive care stay. Animal studies indicate that lung compliance can deteriorate rapidly under conventional ventilation. This study investigated whether this presumed deterioration in compliance actually occurs in extremely small preterm infants.
Data from 56 conventionally ventilated preterm infants born from 2016 to 2022 at 25.22 weeks' gestation (±1.47) and 678.71 g (±138.14) birth weight were retrospectively analysed. This study investigated how dynamic compliance changed over the course of ventilation.
The infants were conventionally ventilated from 7.25 days of life (±5.59) for 2.68 days (±2.35). Compliance at the beginning was 0.37 mL/cmHO/kg (±0.17), after 1 h 0.38 mL/cmHO/kg (±0.16), after 3 h 0.40 mL/cmHO/kg (±0.20), after 6 h 0.44 mL/cmHO/kg (±0.23), after 24 h 0.46 mL/cmHO/kg (±0.17) and after 48 h 0.43 mL/cmHO/kg (±0.13). The increase in compliance compared to baseline was statistically significant after 12 (p = 0.016) and 24 h (p = 0.042). Ventilation was performed with a PEEP of 7.51 cmHO (±1.16) and a peak pressure of 20.64 cmHO (±2.73). All received surfactant after birth and 21 (37.5%) also at the start of conventional ventilation.
During conventional ventilation in premature infants after administration of surfactant and with basically recruited lungs, no deterioration in compliance was observed either in the short or long term. The PEEP of almost 7.5 cmHO used may have contributed to the fact that the deterioration described in the animal model did not occur in the preterm infants.
许多极小的早产儿在重症监护期间需要进行气管插管和机械通气。动物研究表明，在传统通气下肺顺应性可能会迅速恶化。本研究调查了这种假定的顺应性恶化在极小的早产儿中是否实际发生。
回顾性分析了2016年至2022年出生的56例传统通气的早产儿的数据，这些早产儿的孕周为25.22周（±1.47），出生体重为678.71克（±138.14）。本研究调查了动态顺应性在通气过程中是如何变化的。
婴儿从出生后7.25天（±5.59）开始进行传统通气，持续2.68天（±2.35）。开始时的顺应性为0.37 mL/cmH₂O/kg（±0.17），1小时后为0.38 mL/cmH₂O/kg（±0.16），3小时后为0.40 mL/cmH₂O/kg（±0.20），6小时后为0.44 mL/cmH₂O/kg（±0.23），24小时后为0.46 mL/cmH₂O/kg（±0.17），48小时后为0.43 mL/cmH₂O/kg（±0.13）。与基线相比，顺应性在12小时（p = 0.016）和24小时（p = 0.042）后增加具有统计学意义。通气时使用的呼气末正压（PEEP）为7.51 cmH₂O（±1.16），峰值压力为20.64 cmH₂O（±2.73）。所有婴儿出生后均接受了表面活性剂治疗，21例（37.5%）在传统通气开始时也接受了表面活性剂治疗。
在给予表面活性剂且肺基本复张的早产儿进行传统通气期间，无论是短期还是长期，均未观察到顺应性恶化。所使用的近7.5 cmH₂O的呼气末正压可能是动物模型中描述的恶化情况未在早产儿中发生的原因之一。
