Positive Pressure Ventilation in Preterm Infants in the Delivery Room: A Review of Current Practices, Challenges, and Emerging Technologies.

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-03-11 DOI:10.1159/000537800
Shivashankar Diggikar, Viraraghavan V Ramaswamy, Jenny Koo, Arun Prasath, Georg M Schmölzer
{"title":"Positive Pressure Ventilation in Preterm Infants in the Delivery Room: A Review of Current Practices, Challenges, and Emerging Technologies.","authors":"Shivashankar Diggikar, Viraraghavan V Ramaswamy, Jenny Koo, Arun Prasath, Georg M Schmölzer","doi":"10.1159/000537800","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes.</p><p><strong>Summary: </strong>Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials.</p><p><strong>Key messages: </strong>This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.</p>","PeriodicalId":94152,"journal":{"name":"Neonatology","volume":" ","pages":"288-297"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neonatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000537800","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/11 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: A major proportion of preterm neonates require positive pressure ventilation (PPV) immediately after delivery. PPV may be administered through a face mask (FM) or nasal prongs. Current literature indicates that either of these are associated with similar outcomes.

Summary: Nonetheless, FM remains the most utilized and the best choice. However, most available FM sizes are too large for extremely preterm infants, which leads to mask leak and ineffective PPV. Challenges to providing effective PPV include poor respiratory drive, complaint chest wall, weak thoracic muscle, delayed liquid clearance, and surfactant deficiency in preterm infants. Mask leak, airway obstruction, poor technique, and inappropriate size are correctable causes of ineffective PPV. Visual assessment of chest rise is often used to assess the efficacy of PPV. However, its accuracy is debatable. Though end tidal CO2 may adjudge the effectiveness of PPV, clinical studies are limited. The compliance of a preterm lung is highly dynamic. The inflating pressure set on T-piece is constant throughout the resuscitation, but the lung volume and dynamics changes with every breath. This leads to huge fluctuations of tidal volume delivery and can trigger inflammatory cascade in preterm infants leading to brain and lung injury. Respiratory function monitoring in the delivery room has potential for guiding and optimizing delivery room resuscitation. This is, however, limited by high costs, complex information that is difficult to interpret during resuscitation, and absence of clinical trials.

Key messages: This review summarizes the existing literature on PPV in preterm infants, the various aspects related to it such as the pathophysiology, interfaces, devices utilized to deliver it, appropriate technique, emerging technologies, and future directions.

产房早产儿正压通气:当前做法、挑战和新兴技术综述》。
背景:大部分早产新生儿在分娩后需要立即进行正压通气(PPV)。正压通气可通过面罩(FM)或鼻刺进行。摘要:尽管如此,面罩仍是使用率最高的最佳选择。然而,大多数现有的调频尺寸对于极早产儿来说过大,导致面罩泄漏和 PPV 无效。提供有效 PPV 所面临的挑战包括早产儿呼吸动力差、胸壁抱怨、胸肌薄弱、液体清除延迟和表面活性物质缺乏。面罩漏气、气道阻塞、技术不佳和尺寸不当是导致 PPV 无效的可纠正原因。胸部隆起的视觉评估通常用于评估 PPV 的效果。但其准确性值得商榷。虽然潮气末二氧化碳可判断 PPV 的效果,但临床研究有限。早产儿肺的顺应性是高度动态的。在整个复苏过程中,T-piece 上设定的充气压力是恒定的,但每次呼吸时肺部的容积和动态变化都会改变。这导致潮气量输出的巨大波动,并可能引发早产儿的炎症级联反应,导致脑部和肺部损伤。产房呼吸功能监测可用于指导和优化产房复苏。然而,高昂的成本、复苏过程中难以解读的复杂信息以及临床试验的缺失限制了这一潜力:本综述总结了有关早产儿 PPV 的现有文献,以及与之相关的各个方面,如病理生理学、接口、用于提供 PPV 的设备、适当的技术、新兴技术和未来发展方向。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信