Oscillometry for personalizing continuous distending pressure maneuvers: an observational study in extremely preterm infants

IF 4.7 2区医学 Q1 RESPIRATORY SYSTEM

Respiratory Research Pub Date : 2024-01-04 DOI:10.1186/s12931-023-02639-4

Chiara Veneroni, Raffaele L. Dellacà, Erik Küng, Beatrice Bonomi, Angelika Berger, Tobias Werther

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Abstract

Lung recruitment and continuous distending pressure (CDP) titration are critical for assuring the efficacy of high-frequency ventilation (HFOV) in preterm infants. The limitation of oxygenation (peripheral oxygen saturation, SpO2) in optimizing CDP calls for evaluating other non-invasive bedside measurements. Respiratory reactance (Xrs) at 10 Hz measured by oscillometry reflects lung volume recruitment and tissue strain. In particular, lung volume recruitment and decreased tissue strain result in increased Xrs values. In extremely preterm infants treated with HFOV as first intention, we aimed to measure the relationship between CDP and Xrs during SpO2-driven CDP optimization. In this prospective observational study, extremely preterm infants born before 28 weeks of gestation undergoing SpO2-guided lung recruitment maneuvers were included in the study. SpO2 and Xrs were recorded at each CDP step. The optimal CDP identified by oxygenation (CDPOpt_SpO2) was compared to the CDP providing maximal Xrs on the deflation limb of the recruitment maneuver (CDPXrs). We studied 40 infants (gestational age at birth = 22+ 6-27+ 5 wk; postnatal age = 1–23 days). Measurements were well tolerated and provided reliable results in 96% of cases. On average, Xrs decreased during the inflation limb and increased during the deflation limb. Xrs changes were heterogeneous among the infants for the amount of decrease with increasing CDP, the decrease at the lowest CDP of the deflation limb, and the hysteresis of the Xrs vs. CDP curve. In all but five infants, the hysteresis of the Xrs vs. CDP curve suggested effective lung recruitment. CDPOpt_SpO2 and CDPXrs were highly correlated (ρ = 0.71, p < 0.001) and not statistically different (median difference [range] = -1 [-3; 9] cmH2O). However, CDPXrs were equal to CDPOpt_SpO2 in only 6 infants, greater than CDPOpt_SpO2 in 10, and lower in 24 infants. The Xrs changes described provide complementary information to oxygenation. Further investigation is warranted to refine recruitment maneuvers and CPD settings in preterm infants.

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用于个性化持续膨胀压力操作的示波测量法：一项针对极早产儿的观察研究

肺募集和持续膨胀压（CDP）滴定对于确保早产儿高频通气（HFOV）的疗效至关重要。血氧饱和度（外周血氧饱和度，SpO2）在优化 CDP 方面的局限性要求对其他非侵入性床旁测量进行评估。通过振荡测量法测量的 10 Hz 呼吸反应（Xrs）反映了肺容积募集和组织应变。特别是，肺容积募集和组织应变减少会导致 Xrs 值增加。在以 HFOV 作为第一治疗方案的极早产儿中，我们旨在测量 SpO2 驱动的 CDP 优化过程中 CDP 与 Xrs 之间的关系。在这项前瞻性观察研究中，研究对象包括妊娠 28 周前出生的极早产儿，他们都接受了 SpO2 引导下的肺募集操作。每个 CDP 步骤都记录了 SpO2 和 Xrs。通过吸氧确定的最佳 CDP（CDPOpt_SpO2）与在肺募集操作放气肢上提供最大 Xrs 的 CDP（CDPXrs）进行比较。我们对 40 名婴儿（出生时胎龄 = 22+ 6-27+ 5 周；出生后胎龄 = 1-23 天）进行了研究。在 96% 的病例中，测量的耐受性良好，结果可靠。平均而言，Xrs在充气肢时下降，在放气肢时上升。不同婴儿的 Xrs 变化在 CDP 增加时的减少量、放气肢最低 CDP 时的减少量以及 Xrs 与 CDP 曲线的滞后性方面存在差异。除五名婴儿外，其他所有婴儿的 Xrs 与 CDP 曲线的滞后均表明肺有效募集。CDPOpt_SpO2 和 CDPXrs 高度相关（ρ = 0.71，p < 0.001），且无统计学差异（中位数差异 [范围] = -1 [-3; 9] cmH2O）。但是，只有 6 名婴儿的 CDPXrs 与 CDPOpt_SpO2 相等，10 名婴儿的 CDPXrs 大于 CDPOpt_SpO2，24 名婴儿的 CDPXrs 小于 CDPOpt_SpO2。所述的 Xrs 变化为氧合提供了补充信息。有必要进行进一步研究，以完善早产儿的招募操作和 CPD 设置。

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来源期刊

Respiratory Research 医学-呼吸系统

自引率

1.70%

发文量

314

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.