Duration of apnoea before start of backup ventilation during nCPAP in extremely preterm infants and time spent within the SpO2 target: a randomised cross-over study.

IF 3.6 2区 医学 Q1 PEDIATRICS
Stephanie Ströbele, Tibor Jung, Dominik Kraft, Nadine Forsteneichner, Eva-Maria Mair, Lisa Schiefele, Sebastian Schmid, Markus Waitz, Vanessa Linhoff, Antje Westhoff, Jens Dreyhaupt, Keywan Sohrabi, Harald Ehrhardt
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引用次数: 0

Abstract

Objective: Central apnoea due to immaturity of the respiratory drive constitutes the main cause of frequent and prolonged desaturations in extremely preterm (EPT) infants <28 weeks. We investigated the impact of varying the duration of apnoea before backup ventilation (BUV) on the measures of oxygenation in EPT infants during nasal continuous positive airway pressure (nCPAP) therapy.

Design: Single-centre randomised cross-over trial.

Setting: Level 3 neonatal intensive care unit.

Patients: 24 EPT infants on nCPAP with BUV.

Main outcome measures: The primary outcome was the time spent within a predefined oxygen saturation (SpO2) target (88%-95% or ≥88% with fraction of inspired oxygen (FiO2) =0.21) during start of BUV after 4 s of apnoea duration (AD 4) or 16 s of apnoea duration (AD 16) RESULTS: The study was successfully completed in 22 children (median gestational age 24+5 weeks, birth weight 628 g, postnatal age 48 days). Mean time spent within the SpO2 target didn't differ between AD 4 and AD 16 (66.9% vs 67.2%, p=0.88). There were no differences in the time below or above the SpO2 target, prolonged (>30 s, >60 s, >120 s) and severe (<80%, <70%) episodes of hypoxaemias and cerebral tissue oxygenation. Mean FiO2, mean airway pressure, transcutaneous carbon dioxide pressure, heart rate and respiratory frequency did not differ while the rate of BUV was significantly higher during AD 4.

Conclusion: Reducing the time of apnoea until start of BUV didn't improve the time spent within the SpO2 target in respiratory unstable EPT infants. Our data demand intensified efforts to specify these settings of non-invasive respiratory support that better achieve this important clinical goal.

Trial registration number: DRKS00031911.

极早产儿nCPAP期间后备通气开始前的呼吸暂停持续时间和SpO2目标内的时间:一项随机交叉研究
目的:呼吸驱动不成熟导致的中枢性呼吸暂停是极早产儿(EPT)频繁和长时间去饱和的主要原因。环境:三级新生儿重症监护病房。患者:24例EPT患儿接受nCPAP合并BUV治疗。主要结局指标:主要结局指标是在4 s呼吸暂停持续时间(AD 4)或16 s呼吸暂停持续时间(AD 16)后BUV开始时在预定的氧饱和度(SpO2)目标(88%-95%或≥88%吸入氧分数(FiO2) =0.21)内度过的时间。结果:22名儿童(中位胎龄24+5周,出生体重628 g,出生后48天)成功完成研究。在AD 4和AD 16中,SpO2目标内的平均时间没有差异(66.9% vs 67.2%, p=0.88)。SpO2低于或高于目标时间、延长时间(bbb30 s、bbb60 s、>20 s)和严重时间(>20 s)无差异,平均气道压、经皮二氧化碳压、心率和呼吸频率在AD 4期间无差异,但BUV率明显升高。结论:减少呼吸不稳定EPT患儿的呼吸暂停时间并不能改善其SpO2目标时间。我们的数据需要加强努力,明确这些无创呼吸支持的设置,以更好地实现这一重要的临床目标。试验注册号:DRKS00031911。
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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