Ebony R Cannata, Kelly J Crossley, Erin V McGillick, Megan J Wallace, Michelle K Croughan, Dominic Jurkschat, Sophie J E Cramer, Arjan B Te Pas, Stuart B Hooper, Marcus J Kitchen
{"title":"Optimising CPAP and oxygen levels to support spontaneous breathing in preterm rabbits.","authors":"Ebony R Cannata, Kelly J Crossley, Erin V McGillick, Megan J Wallace, Michelle K Croughan, Dominic Jurkschat, Sophie J E Cramer, Arjan B Te Pas, Stuart B Hooper, Marcus J Kitchen","doi":"10.1038/s41390-025-03802-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Very preterm infants often require respiratory support after birth with current recommendations suggesting the use of continuous positive airway pressure (CPAP) of 4-8 cmH<sub>2</sub>O and an initial fraction of inspired oxygen (FiO<sub>2</sub>) of 0.21-0.3. We have examined the interaction of high and low CPAP and FiO<sub>2</sub> levels on breathing rates and lung aeration in preterm rabbits.</p><p><strong>Methods: </strong>Prematurely delivered rabbits (29/32 days gestation) received CPAP of either 5cmH<sub>2</sub>O (5CPAP; n = 12) or 15 cmH<sub>2</sub>O (15CPAP; n = 14), and a FiO<sub>2</sub> of either 0.3 (5CPAP/0.3, n = 6 or 15CPAP/0.3, n = 7) or 0.6 (5CPAP/0.6, n = 6 or 15CPAP/0.6, n = 7). Breathing rates, lung aeration (functional residual capacity; FRC), lung bulging and air accumulation in the stomach were measured using phase-contrast X-ray imaging.</p><p><strong>Results: </strong>Kittens receiving 0.6 FiO<sub>2</sub> had higher breathing rates (5CPAP/0.6: 32.6±6.4 breaths/min; p = 0.0064 and 15CPAP/0.6: 36.9±3.5breaths/min; p = 0.0010) than 5CPAP/0.3 kittens (11.8±4.1breaths/min). Kittens receiving 15CPAP/0.6 tended to have higher FRC volumes (34.9±4 mL/kg) than kittens receiving 5 cmH<sub>2</sub>O CPAP (5CPAP/0.3: 13.1±6mL/kg; p = 0.0675 and 5CPAP/0.6: 13.5±6 mL/kg; p = 0.1720) and 15CPAP/0.3 (22.5 ± 6.6 mL/kg; p = 0.4245). Lung bulging and air accumulation in the stomach were not different between groups.</p><p><strong>Conclusion: </strong>Preterm rabbits supported with both 15 cmH<sub>2</sub>O CPAP and 0.6 FiO<sub>2</sub> increased spontaneous breathing rates and lung aeration without increasing the risk of air in the stomach or lung bulging.</p><p><strong>Impact: </strong>While current guidelines recommend the use of low CPAP (4-8 cmH<sub>2</sub>O) and low FiO<sub>2</sub> levels (0.21-0.3 FiO<sub>2</sub>) to support preterm infants at birth, the optimum levels are unknown. This study has shown that 15 cmH<sub>2</sub>O of CPAP and FiO<sub>2</sub> of 0.6 improved lung aeration and breathing in preterm rabbits, compared with a CPAP of 4 cmH<sub>2</sub>O and FiO<sub>2</sub> of 0.3. These results add to the evidence indicating that initial high CPAP and high FiO<sub>2</sub> levels, followed by titration of both, enhance respiratory support for preterm newborns.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41390-025-03802-x","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Very preterm infants often require respiratory support after birth with current recommendations suggesting the use of continuous positive airway pressure (CPAP) of 4-8 cmH2O and an initial fraction of inspired oxygen (FiO2) of 0.21-0.3. We have examined the interaction of high and low CPAP and FiO2 levels on breathing rates and lung aeration in preterm rabbits.
Methods: Prematurely delivered rabbits (29/32 days gestation) received CPAP of either 5cmH2O (5CPAP; n = 12) or 15 cmH2O (15CPAP; n = 14), and a FiO2 of either 0.3 (5CPAP/0.3, n = 6 or 15CPAP/0.3, n = 7) or 0.6 (5CPAP/0.6, n = 6 or 15CPAP/0.6, n = 7). Breathing rates, lung aeration (functional residual capacity; FRC), lung bulging and air accumulation in the stomach were measured using phase-contrast X-ray imaging.
Results: Kittens receiving 0.6 FiO2 had higher breathing rates (5CPAP/0.6: 32.6±6.4 breaths/min; p = 0.0064 and 15CPAP/0.6: 36.9±3.5breaths/min; p = 0.0010) than 5CPAP/0.3 kittens (11.8±4.1breaths/min). Kittens receiving 15CPAP/0.6 tended to have higher FRC volumes (34.9±4 mL/kg) than kittens receiving 5 cmH2O CPAP (5CPAP/0.3: 13.1±6mL/kg; p = 0.0675 and 5CPAP/0.6: 13.5±6 mL/kg; p = 0.1720) and 15CPAP/0.3 (22.5 ± 6.6 mL/kg; p = 0.4245). Lung bulging and air accumulation in the stomach were not different between groups.
Conclusion: Preterm rabbits supported with both 15 cmH2O CPAP and 0.6 FiO2 increased spontaneous breathing rates and lung aeration without increasing the risk of air in the stomach or lung bulging.
Impact: While current guidelines recommend the use of low CPAP (4-8 cmH2O) and low FiO2 levels (0.21-0.3 FiO2) to support preterm infants at birth, the optimum levels are unknown. This study has shown that 15 cmH2O of CPAP and FiO2 of 0.6 improved lung aeration and breathing in preterm rabbits, compared with a CPAP of 4 cmH2O and FiO2 of 0.3. These results add to the evidence indicating that initial high CPAP and high FiO2 levels, followed by titration of both, enhance respiratory support for preterm newborns.
期刊介绍：
Pediatric Research publishes original papers, invited reviews, and commentaries on the etiologies of children''s diseases and
disorders of development, extending from molecular biology to epidemiology. Use of model organisms and in vitro techniques
relevant to developmental biology and medicine are acceptable, as are translational human studies
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