Respiratory function monitoring for neonatal resuscitation: a narrative review.

IF 3.6 2区 医学 Q1 PEDIATRICS
Neaha Patel, Lee Prior Collier, Arameh Aghababaie, Burak Salgin
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引用次数: 0

Abstract

Newborn infants must undergo complex physiological changes when transitioning from fetal to extrauterine life, including rapid lung aeration, fluid clearance and major haemodynamic shifts. Although the majority breathe spontaneously, a significant minority may require respiratory support. Resuscitation guidelines recommend face-mask positive pressure ventilation with a T-piece resuscitator, but effectiveness in the delivery room (DR) is typically assessed by subjective measures such as chest wall movement.This narrative review summarises the evidence regarding the use of respiratory function monitors (RFMs) to provide real-time objective feedback on tidal volumes, pressures and mask leak during DR resuscitation. We examine the potential for RFMs to reduce the risk of both underventilation and overventilation and whether their employment in the first few hours of life could mitigate long-term complications such as bronchopulmonary dysplasia and intraventricular haemorrhage. We also explore practical considerations such as sensor technology, dead space, staff training, usability and cost-effectiveness. While systematic reviews and major international guidelines have not yet endorsed their routine implementation, citing limited randomised controlled trial data, multiple observational studies demonstrate that RFMs can improve DR ventilation. Ultimately, RFMs may facilitate individualised, lung-protective approaches to DR ventilation, particularly in vulnerable preterm infants. Future directions include high-quality trials with comprehensive clinical outcomes, cost-effectiveness evaluations and clarifications of training requirements for effective RFM use.

新生儿复苏呼吸功能监测:叙述性回顾。
新生儿从胎儿过渡到宫外生活时必须经历复杂的生理变化,包括快速肺通气、液体清除和主要的血流动力学变化。虽然大多数人可以自主呼吸,但也有少数人需要呼吸辅助。复苏指南建议使用t件式复苏器进行面罩正压通气,但在产房(DR)的有效性通常是通过胸壁运动等主观测量来评估的。这篇叙述性综述总结了关于使用呼吸功能监测仪(rfm)在DR复苏期间提供潮汐量、压力和面罩泄漏的实时客观反馈的证据。我们研究了rfm降低通气不足和过度通气风险的潜力,以及在生命最初几个小时内使用rfm是否可以减轻支气管肺发育不良和脑室内出血等长期并发症。我们还探讨了实际考虑因素,如传感器技术、死区、员工培训、可用性和成本效益。虽然系统评价和主要国际指南尚未认可其常规实施,引用有限的随机对照试验数据,但多项观察性研究表明,rfm可以改善DR通气。最终,rfm可以促进个体化、肺保护的DR通气方法,特别是对易感早产儿。未来的方向包括具有全面临床结果的高质量试验,成本效益评估和澄清有效使用RFM的培训要求。
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
CiteScore
9.00
自引率
4.50%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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