神经调节通气辅助启动后，患有进展性或已确诊支气管肺发育不良的早产儿的呼吸生理变化。
Respiratory physiological changes post initiation of neurally adjusted ventilatory assist in preterm infants with evolving or established bronchopulmonary dysplasia.
作者信息
Mohamed Basma, Kulkarni Anay, Duffy Donovan, Greenough Anne, Shetty Sandeep
机构信息
Neonatal Intensive Care Centre, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK.
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
出版信息
Eur J Pediatr. 2025 Jan 29;184(2):159. doi: 10.1007/s00431-025-05997-x.
To assess respiratory changes after neurally adjusted ventilatory assist (NAVA) initiation in preterm infants with evolving or established bronchopulmonary dysplasia (BPD). Premature infants born less than 32 weeks gestation with evolving or established BPD initiated on invasive or non-invasive (NIV) NAVA were included. Respiratory data: PCO and SpO₂/FiO₂ (S/F) ratio before and at 4, 24, 48 h post-NAVA initiation were collected. Eighty-eight infants, median GA 25.1 (range 22.7-30.3) weeks, with 191 NAVA episodes were included. Infants born < 32 weeks with evolving and established BPD showed improvements in PCO and S/F ratio 48 h post-NAVA compared to prior: 7.6 (4.5-11.8) versus 8.1 (4.7-13.1) kPa; p < 0.001 and 285 (118-471) versus 276 (103-471); p = 0.013, respectively. Improvements were observed in invasive NAVA: 7.6 (4.5-11.8) versus 8.5 (4.7-12.4) kPa; p = 0.001, 290 (148-471) versus 271 (103-467); p = 0.002, and NIV-NAVA: 7.5 (4.6-11.7) versus 7.9 (5.2-13.1) kPa; p = 0.001, 283 (128-471) versus 294 (114-471); p = 0.002. Severe BPD infants had reductions in PCO 48 h post-initiation: 7.2 (5.6-9.7) versus 8.0 (5.4-11.7) kPa; p = 0.002, with lower FiO₂ requirements 0.37 (0.21-0.65) versus 0.43 (0.21-0.8); p = 0.011, and improved S/F ratios 263 (146-471) versus 219 (114-457); p = 0.006. On subgroup analysis, similar improvements were noted in; PCO levels in invasive NAVA (p = 0.011) and NIV-NAVA (p = 0.002), S/F ratios in invasive NAVA (p = 0.046) and NIV-NAVA (p = 0.002) and FiO₂ in invasive NAVA (p = 0.034) and NIV-NAVA (p = 0.053).Conclusion: NAVA improves CO clearance and oxygenation in infants with evolving or established and severe BPD at 48 h post-initiation. In severe BPD, NAVA also reduced oxygen requirements What is Known: • NAVA has the potential to improve CO clearance and oxygenation by optimising alveolar ventilation, adapting to the infant's breathing patterns, and enhancing gas exchange. What is New: • The beneficial effects of NAVA are sustained in infants with evolving or established bronchopulmonary dysplasia (BPD), improving carbon dioxide clearance and oxygenation at 48 hours after initiation.
评估神经调节通气辅助（NAVA）应用于患有进展性或已确诊支气管肺发育不良（BPD）的早产儿后呼吸的变化。纳入小于32周胎龄、患有进展性或已确诊BPD且开始接受有创或无创（NIV）NAVA治疗的早产儿。收集呼吸数据：NAVA开始前以及开始后4、24、48小时的PCO₂和SpO₂/FiO₂（S/F）比值。纳入了88例婴儿，中位胎龄25.1（范围22.7 - 30.3）周，共191次NAVA治疗。与之前相比，出生孕周<32周且患有进展性和已确诊BPD的婴儿在NAVA开始后48小时PCO₂和S/F比值有所改善：分别为7.6（4.5 - 11.8）与8.1（4.7 - 13.1）kPa；p<0.001以及285（118 - 471）与276（103 - 471）；p = 0.013。在有创NAVA中观察到改善：7.6（4.5 - 11.8）与8.5（4.7 - 12.4）kPa；p = 0.001，290（148 - 471）与271（103 - 467）；p = 0.002，以及无创NAVA：7.5（4.6 - 11.7）与7.9（5.2 - 13.1）kPa；p = 0.001，283（128 - 471）与294（114 - 471）；p = 0.002。患有重度BPD的婴儿在开始治疗后48小时PCO₂降低：7.2（5.6 - 9.7）与8.0（5.4 - 11.7）kPa；p = 0.002，所需FiO₂更低，为0.37（0.21 - 0.65）与0.43（0.21 - 0.8）；p = 0.011，且S/F比值改善，为263（146 - 471）与219（114 - 457）；p = 0.006。亚组分析显示，在有创NAVA（p = 0.011）和无创NAVA（p = 0.002）中的PCO₂水平、有创NAVA（p = 0.046）和无创NAVA（p = 0.002）中的S/F比值以及有创NAVA（p = 0.034）和无创NAVA（p = 0.053）中的FiO₂方面观察到类似改善。结论：NAVA在开始治疗后48小时可改善患有进展性或已确诊以及重度BPD婴儿的二氧化碳清除和氧合情况。在重度BPD中，NAVA还可降低氧需求。已知信息：•NAVA有潜力通过优化肺泡通气、适应婴儿呼吸模式和增强气体交换来改善二氧化碳清除和氧合。新发现：•NAVA对患有进展性或已确诊支气管肺发育不良（BPD）的婴儿有益，在开始治疗后48小时可改善二氧化碳清除和氧合。
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