Invasive ventilation at the boundary of viability: A respiratory pathophysiology study of infants born between 22 and 24 weeks of gestation

IF 1.9 4区医学 Q3 PHYSIOLOGY

Respiratory Physiology & Neurobiology Pub Date : 2024-09-03 DOI:10.1016/j.resp.2024.104339

Theodore Dassios , Richard Sindelar , Emma Williams , Ourania Kaltsogianni , Anne Greenough

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引用次数: 0

Abstract

Background

Invasive ventilation of infants born before 24 weeks of gestation is critical for survival and long-term respiratory outcomes, but currently there is a lack of evidence to guide respiratory management. We aimed to compare respiratory mechanics and gas exchange in ventilated extremely preterm infants born before and after 24 weeks of gestation.

Methods

Secondary analysis of two prospective observational cohort studies, comparing respiratory mechanics and indices of gas exchange in ventilated infants born at 22–24 weeks of gestation (N=14) compared to infants born at 25–27 weeks (N=37). The ventilation/perfusion ratio (V_A/Q), intrapulmonary shunt, alveolar dead space (V_Dalv) and adjusted alveolar surface area (S_A) were measured in infants born at the Neonatal Unit of King’s College Hospital NHS Foundation Trust, London, UK.

Results

Compared to infants of 25–27 weeks, infants of 22–24 weeks had higher median (IQR) intrapulmonary shunt [18 (4 - 29) % vs 8 (2 – 12) %, p=0.044] and higher V_Dalv [0.9 (0.6 – 1.4) vs 0.6 (0.5 – 0.7) ml/kg, p=0.036], but did not differ in V_A/Q. Compared to infants of 25–27 weeks, the infants of 22–24 weeks had a lower adjusted S_A [509 (322- 687) vs 706 (564 - 800) cm², p=0.044]. The infants in the two groups did not differ in any of the indices of respiratory mechanics.

Conclusion

Ventilated infants born before 24 completed weeks of gestation exhibit abnormal gas exchange, with higher alveolar dead space and intrapulmonary shunt and a decreased alveolar surface area compared to extreme preterms born after 24 weeks of gestation.

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存活边界的侵入性通气：妊娠 22-24 周间出生婴儿的呼吸病理生理学研究。

背景：对妊娠 24 周前出生的婴儿进行有创通气对其存活和长期呼吸预后至关重要，但目前缺乏指导呼吸管理的证据。我们旨在比较妊娠 24 周之前和之后出生的极早产儿通气后的呼吸力学和气体交换情况：对两项前瞻性观察队列研究进行二次分析，比较妊娠 22-24 周出生的通气婴儿（14 例）与妊娠 25-27 周出生的婴儿（37 例）的呼吸力学和气体交换指数。在英国伦敦国王学院医院 NHS 基金会信托基金会新生儿科出生的婴儿中测量了通气/灌注比（VA/Q）、肺内分流、肺泡死腔（VDalv）和调整后的肺泡表面积（SA）：与 25-27 周的婴儿相比，22-24 周的婴儿肺内分流中位数（IQR）较高[18 (4 - 29) % vs 8 (2 - 12) %，p=0.044]，VDalv 较高[0.9 (0.6 - 1.4) vs 0.6 (0.5 - 0.7) ml/kg，p=0.036]，但 VA/Q 没有差异。与 25-27 周的婴儿相比，22-24 周的婴儿调整后的 SA 值较低 [509 (322-687) vs 706 (564-800) cm2, p=0.044]。两组婴儿在任何呼吸力学指标上都没有差异：结论：与妊娠 24 周后出生的极端早产儿相比，妊娠 24 周前出生的通气婴儿表现出气体交换异常，肺泡死腔和肺内分流较高，肺泡表面积较小。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory Physiology & Neurobiology 医学-呼吸系统

CiteScore

4.80

自引率

8.70%

发文量

104

审稿时长

54 days

期刊介绍： Respiratory Physiology & Neurobiology (RESPNB) publishes original articles and invited reviews concerning physiology and pathophysiology of respiration in its broadest sense. Although a special focus is on topics in neurobiology, high quality papers in respiratory molecular and cellular biology are also welcome, as are high-quality papers in traditional areas, such as: -Mechanics of breathing- Gas exchange and acid-base balance- Respiration at rest and exercise- Respiration in unusual conditions, like high or low pressure or changes of temperature, low ambient oxygen- Embryonic and adult respiration- Comparative respiratory physiology. Papers on clinical aspects, original methods, as well as theoretical papers are also considered as long as they foster the understanding of respiratory physiology and pathophysiology.