Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

Springer Science and Business Media LLC - Tập 14 - Trang 1-10 - 2014
Graeme R Polglase1, David G Tingay2,3,4,5, Risha Bhatia2,3,5, Clare A Berry6,7, Robert J Kopotic8, Clinton P Kopotic8, Yong Song6,7, Edgardo Szyld9, Alan H Jobe10, Jane J Pillow6,7,11
1The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia
2Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
3Neonatal Research, The Royal Women’s Hospital, Melbourne, Australia
4Neonatology, The Royal Children’s Hospital, Melbourne, Australia
5Department of Paediatrics, University of Melbourne, Melbourne, Australia
6Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
7School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Australia
8CAS Medical Systems Inc, Branford, USA
9Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
10Cincinnati Children’s Hospital Medical Centre, Cincinnati, USA
11Neonatal Clinical Care Unit, Women and Newborn Health Service, King Edward Memorial Hospital, Subiaco, Australia

Tóm tắt

Sustained inflations (SI) are advocated for the rapid establishment of FRC after birth in preterm and term infants requiring resuscitation. However, the most appropriate way to deliver a SI is poorly understood. We investigated whether a volume-limited SI improved the establishment of FRC and ventilation homogeneity and reduced lung inflammation/injury compared to a pressure-limited SI. 131 d gestation lambs were resuscitated with either: i) pressure-limited SI (PressSI: 0-40 cmH2O over 5 s, maintained until 20 s); or ii) volume-limited SI (VolSI: 0-15 mL/kg over 5 s, maintained until 20 s). Following the SI, all lambs were ventilated using volume-controlled ventilation (7 mL/kg tidal volume) for 15 min. Lung mechanics, regional ventilation distribution (electrical impedance tomography), cerebral tissue oxygenation index (near infrared spectroscopy), arterial pressures and blood gas values were recorded regularly. Pressure-volume curves were performed in-situ post-mortem and early markers of lung injury were assessed. Compared to a pressure-limited SI, a volume-limited SI had increased pressure variability but reduced volume variability. Each SI strategy achieved similar end-inflation lung volumes and regional ventilation homogeneity. Volume-limited SI increased heart-rate and arterial pressure faster than pressure-limited SI lambs, but no differences were observed after 30 s. Volume-limited SI had increased arterial-alveolar oxygen difference due to higher FiO2 at 15 min (p = 0.01 and p = 0.02 respectively). No other inter-group differences in arterial or cerebral oxygenation, blood pressures or early markers of lung injury were evident. With the exception of inferior oxygenation, a sustained inflation targeting delivery to preterm lambs of 15 mL/kg volume by 5 s did not influence physiological variables or early markers of lung inflammation and injury at 15 min compared to a standard pressure-limited sustained inflation.

Tài liệu tham khảo

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