Cindy T McEvoy, Kelvin D MacDonald, Mitzi A Go, Kristin Milner, Julia Harris, Diane Schilling, Matthew Olson, Christina Tiller, James E Slaven, Jeffrey Bjerregaard, Annette Vu, Alec Martin, Rachna Mamidi, Robert L Schelonka, Cynthia D Morris, Robert S Tepper
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One hundred infants were randomized to eCPAP versus CPAP discontinuation (dCPAP) to room air. <b>Measurements and Main Results:</b> The primary outcome was Va by the single breath hold technique at 6 months corrected age. Secondary outcomes included Dl<sub>CO</sub> and forced expiratory flows (FEFs). FRC was measured in the NICU. Infants randomized to eCPAP (<i>n</i> = 54) versus dCPAP (<i>n</i> = 46) had the following measurements shown as adjusted mean (SE): Va (500.2 [24.9] vs. 418.1 [23.4] ml; adjusted mean difference, 82.1 [95% confidence interval (CI), 8.3-155.9]; <i>P</i> = 0.033); Dl<sub>CO</sub> (3.4 [0.2] vs. 2.8 [0.1] ml/min/mm Hg; adjusted mean difference, 0.6 [95% CI, 0.1-1.1]; <i>P</i> = 0.018); measurement of FEF at 50% of the expired volume (500.6 [18.2] vs. 437.9 [17.9] ml/s; adjusted mean difference, 62.7 [95% CI, 4.5-121.0]; <i>P</i> = 0.039); FEF between 25% and 75% of expired volume (452.0 [17.4] vs. 394.4 [17.4] ml/s; adjusted mean difference, 57.5 [95% CI, 1.3-113.8]; <i>P</i> = 0.046). <b>Conclusions:</b> Infants randomized to eCPAP versus dCPAP had significantly increased Va at 6 months corrected age. Dl<sub>CO</sub> and FEFs were also increased. Extending CPAP in stable preterm infants in the NICU may be a nonpharmacologic and safe therapy to promote lung growth. 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引用次数: 0
摘要
理由：在新生儿重症监护病房（NICU）为稳定的早产儿延长持续气道正压通气（eCPAP）增加肺容量。其对出院后肺生长的影响尚不清楚。目的：评估稳定期早产儿2周eCPAP是否与6月龄时肺泡容积（VA）增加有关。方法：在俄勒冈健康与科学大学进行随机对照试验。门诊评估员不知道治疗分配。100名婴儿随机分为eCPAP组和CPAP中止组（dCPAP）。测量：主要结果是在校正年龄6个月时通过单次屏气技术进行VA。次要结局包括肺对一氧化碳的扩散能力（DL）和用力呼气流量（FEFs）。在新生儿重症监护病房测量功能剩余容量（FRC）。主要结果：随机分配到eCPAP组（n=54）和dCPAP组（n=46）的婴儿有以下测量结果：调整平均[SE]: VA (5002 [24.9] vs 418.1 [23.4] mL；校正平均差为82.1 [95% CI, 8.3-155.9]；p = 0.033);DL (3.4 [0.2] vs 2.8 [0.1] mL/min/mmHg；校正平均差为0.6 [95% CI, 0.1-1.1]；P = 0.018)；FEF50 (500.6 [18.2] vs 437.9 [17.9] mL/sec；校正平均差为62.7 [95% CI 4.5-121.0]；P = 0.039)；FEF25-75 (452.0 [17.4] vs 394.4 [17.4] mL/sec；校正平均差为57.5 [95% CI 1.3-113.8]；p = 0.046)。结论：随机选择eCPAP与dCPAP的婴儿在6个月矫正年龄时VA显著增加。DL和fef均升高。新生儿重症监护室稳定早产儿延长CPAP可能是一种促进肺生长的非药物和安全的治疗方法。临床试验注册可在www.Clinicaltrials: gov, ID: NCT04295564。
Extended Continuous Positive Airway Pressure in Preterm Infants Increases Lung Growth at 6 Months: A Randomized Controlled Trial.
Rationale: Extended continuous positive airway pressure (eCPAP) in the neonatal ICU (NICU) for stable preterm infants increases lung volumes. Its effect on lung growth after discharge is unknown. Objectives: To assess whether 2 weeks of eCPAP in stable preterm infants is associated with increased alveolar volume (Va) at 6 months corrected age. Methods: This randomized controlled trial was conducted at Oregon Health & Science University. Outpatient assessors were unaware of treatment assignment. One hundred infants were randomized to eCPAP versus CPAP discontinuation (dCPAP) to room air. Measurements and Main Results: The primary outcome was Va by the single breath hold technique at 6 months corrected age. Secondary outcomes included DlCO and forced expiratory flows (FEFs). FRC was measured in the NICU. Infants randomized to eCPAP (n = 54) versus dCPAP (n = 46) had the following measurements shown as adjusted mean (SE): Va (500.2 [24.9] vs. 418.1 [23.4] ml; adjusted mean difference, 82.1 [95% confidence interval (CI), 8.3-155.9]; P = 0.033); DlCO (3.4 [0.2] vs. 2.8 [0.1] ml/min/mm Hg; adjusted mean difference, 0.6 [95% CI, 0.1-1.1]; P = 0.018); measurement of FEF at 50% of the expired volume (500.6 [18.2] vs. 437.9 [17.9] ml/s; adjusted mean difference, 62.7 [95% CI, 4.5-121.0]; P = 0.039); FEF between 25% and 75% of expired volume (452.0 [17.4] vs. 394.4 [17.4] ml/s; adjusted mean difference, 57.5 [95% CI, 1.3-113.8]; P = 0.046). Conclusions: Infants randomized to eCPAP versus dCPAP had significantly increased Va at 6 months corrected age. DlCO and FEFs were also increased. Extending CPAP in stable preterm infants in the NICU may be a nonpharmacologic and safe therapy to promote lung growth. Clinical trial registered with www.clinicaltrials.gov (NCT04295564).
期刊介绍：
The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences.
A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.
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