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

BMC Pediatrics

Jane J Pillow⁴  Alan H Jobe²  Edgardo Szyld⁶  Yong Song⁴  Clinton P Kopotic³  Robert J Kopotic³  Clare A Berry⁴  Risha Bhatia¹  David G Tingay¹  Graeme R Polglase⁵ 

[1] Department of Paediatrics, University of Melbourne, Melbourne, Australia;Cincinnati Children’s Hospital Medical Centre, Cincinnati, Ohio, USA;CAS Medical Systems Inc, Branford, CT, USA;School of Anatomy, Physiology and Human Biology, The University of Western Australia, Crawley, Western Australia 6009, Australia;The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria 3168, Australia;Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, USA

关键词: Variability;    Ventilation homogeneity;    Lung recruitment;    Infant, newborn;    Mechanical ventilation;   

Others  :  1139021
DOI  :  10.1186/1471-2431-14-43

 received in 2013-08-07, accepted in 2014-02-05,  发布年份 2014

【 摘 要 】

Background

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.

Methods

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.

Results

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.

Conclusion

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.

【 授权许可】

   
2014 Polglase et al.; licensee BioMed Central Ltd.

【 图 表 】

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