Effect of different CPAP levels on ultrasound-assessed lung aeration and gas exchange in neonates.

IF 5.8 2区 医学 Q1 Medicine Respiratory Research Pub Date : 2024-10-17 DOI:10.1186/s12931-024-03010-x
Victor Sartorius, Barbara Loi, Laura Vivalda, Giulia Regiroli, Sofia De La Rubia-Ortega, Lucilla Pezza, Manon Midevaine, Shivani Shankar-Aguilera, Rafik Ben-Ammar, Daniele De Luca
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Abstract

Background: Respiratory distress syndrome (RDS) and transient tachypnoea (TTN) are the two commonest neonatal respiratory disorders. The optimal continuous positive airway pressure (CPAP) to treat them is unknown. We aim to clarify the effect of different CPAP levels on lung aeration and gas exchange in patients with RDS and TTN.

Methods: Prospective, observational, pragmatic, physiological cohort study. CPAP was sequentially increased from 4 to 6 and 8 cmH2O and backwards, with interposed wash-out periods. Lung aeration was assessed with a validated neonatal lung ultrasound score. Gas exchange was non-invasively evaluated with transcutaneous monitoring. Ultrasound score and PtcO2/FiO2 ratio were the co-primary outcomes. PtcCO2 and other oxygenation metrics were the secondary outcomes.

Results: 30 neonates with RDS and 30 with TTN were studied. Each CPAP increment significantly (overall always p < 0.001) improved both lung aeration and oxygenation, but the increase from 6 to 8 cmH2O achieved a small absolute benefit. In RDS patients, the absolute improvements were small and the diagnosis of TTN was significantly associated with greater improvement of lung aeration (β= -1.4 (95%CI: -2.4; -0.3), p = 0.01) and oxygenation (β = 39.6 (95%CI: 4.1; 75.1), p = 0.029). Aeration improved in 16 (53.3%) and 27 (90%) patients in the RDS and TTN groups, respectively (p = 0.034). Lung aeration showed significant hysteresis in TTN patients. Secondary outcomes gave similar results.

Conclusions: Increasing CPAP from 4 to 8 cmH2O improves ultrasound-assessed lung aeration and oxygenation in RDS and TTN. The absolute improvements are small when CPAP is beyond 6 cmH2O or for RDS patients.

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不同 CPAP 水平对新生儿超声评估肺通气和气体交换的影响。
背景:呼吸窘迫综合征(RDS)和一过性呼吸困难(TTN)是两种最常见的新生儿呼吸系统疾病。治疗这两种疾病的最佳持续气道正压(CPAP)尚不清楚。我们旨在明确不同 CPAP 水平对 RDS 和 TTN 患者肺通气和气体交换的影响:前瞻性、观察性、实用性、生理学队列研究。将 CPAP 从 4 cmH2O 顺序增加到 6 cmH2O 和 8 cmH2O,然后再向后增加,中间有一段冲洗期。通过有效的新生儿肺部超声评分评估肺通气情况。通过经皮监测对气体交换进行无创评估。超声评分和 PtcO2/FiO2 比率是共同的主要结果。PtcCO2和其他氧合指标为次要结果:研究对象包括 30 名患有 RDS 的新生儿和 30 名患有 TTN 的新生儿。CPAP 的每一增量都能明显(总体上总是 p 2O )获得微小的绝对益处。在 RDS 患者中,绝对改善程度较小,而 TTN 诊断与肺通气(β=-1.4 (95%CI: -2.4; -0.3),p = 0.01)和氧饱和度(β=39.6 (95%CI: 4.1; 75.1),p = 0.029)的改善程度显著相关。RDS 组和 TTN 组分别有 16 名(53.3%)和 27 名(90%)患者的通气状况有所改善(p = 0.034)。TTN患者的肺通气性显示出明显的滞后性。次要结果显示出相似的结果:将 CPAP 从 4 cmH2O 提高到 8 cmH2O 可改善 RDS 和 TTN 患者的超声评估肺通气和氧合情况。CPAP 超过 6 cmH2O 或 RDS 患者的绝对改善程度较小。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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