Zuiki Masashi, Watanabe Kazunori, Iwata Norihiro, Mitsuno Rika, Konishi Madoka, Yamano Akio, Ichise Eisuke, Morimoto Hidechika, Hashiguchi Kanae, Hasegawa Tatsuji, Iehara Tomoko
Department of Paediatrics, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan.
Biomedicines. 2025 Sep 16;13(9):2275. doi: 10.3390/biomedicines13092275.
Identifying the optimal positive end-expiratory pressure (PEEP) is a major challenge in implementing strategies to prevent ventilator-induced lung injury in newborns. In this study, we assessed the validity of volumetric capnography based on the neonatal patient monitor (V) technique and investigated the impact of PEEP on newborns. Analysis 1 evaluated the validity of the V technique with data from pediatric patients receiving invasive respiratory support. Linear regression and Bland-Altman analyses were performed on V and HAMILTON-C1 data. Analysis 2 evaluated the impact of PEEP on newborns. The PEEP level was increased from mild to high (the incremental phase) and then decreased from high to mild (the decremental phase) while performing the V technique on term and preterm infants. Analysis 1 included 31 children (age, 9 [interquartile range (IQR), 0-36] months; weight, 6.0 [IQR, 3.8-10.5] kg). Regression and Bland-Altman analyses demonstrated the accuracy of V. Analysis 2 included 28 term (mean gestational age, 38 [IQR, 38-40] weeks; weight, 2924 [IQR, 2725-3109] g) and 21 preterm (mean gestational age, 33 [IQR, 31-34] weeks; weight, 1918 [IQR, 1356-2186] g) newborns. Despite no difference in tidal volume, high PEEP significantly increased airway dead space and decreased alveolar tidal volume compared to mild PEEP in each phase in term and preterm neonates. High PEEP induced airway dilation in newborns, as determined using a novel V technique. This technique, which requires no special equipment, has the potential for wider clinical application in neonatal care.
确定最佳呼气末正压（PEEP）是实施预防新生儿呼吸机相关性肺损伤策略的一项重大挑战。在本研究中，我们评估了基于新生儿患者监护仪（V）技术的容量式二氧化碳描记法的有效性，并研究了PEEP对新生儿的影响。分析1使用接受有创呼吸支持的儿科患者的数据评估了V技术的有效性。对V和HAMILTON-C1数据进行了线性回归分析和布兰德-奥特曼分析。分析2评估了PEEP对新生儿的影响。在对足月儿和早产儿进行V技术操作时，将PEEP水平从轻度增加到重度（递增阶段），然后从重度降低到轻度（递减阶段）。分析1纳入了31名儿童（年龄9[四分位间距（IQR），0 - 36]个月；体重6.0[IQR，3.8 - 10.5]kg）。回归分析和布兰德-奥特曼分析证明了V的准确性。分析2纳入了28名足月儿（平均胎龄38[IQR，38 - 40]周；体重2924[IQR，2725 - 3109]g）和21名早产儿（平均胎龄33[IQR，31 - 34]周；体重1918[IQR，1356 - 2186]g）。尽管潮气量无差异，但与轻度PEEP相比，在足月儿和早产儿的每个阶段，高PEEP均显著增加气道死腔并降低肺泡潮气量。使用一种新的V技术确定，高PEEP可导致新生儿气道扩张。这种无需特殊设备的技术在新生儿护理中具有更广泛临床应用的潜力。
