{"title":"早产儿无创呼吸支持期间气体温度和相对湿度的优化控制:一种简单而低成本的干预措施。","authors":"Karina Segatto, Renata Monteiro Weigert, Mariane Ferreira da Silveira, Fabiano Frâncio, Kelen Salvagni, Simone Caldeira Silva, Sergio Tadeu Martins Marba, Guilherme Sant'Anna","doi":"10.1177/19345798241291348","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> During non-invasive respiratory support, administration of gases at high flow rates requires proper air conditioning to avoid upper airways complications. However, closed-loop control of temperature & relative humidity (T&RH) of mixed gases systems with wired-heated circuits are not commonly available in low-middle income countries (LMIC). Thus, a policy for close control of gas T&RH to overcome our system limitations was implemented. The objective of this study was to evaluate the impact of this intervention.<b>Method:</b> Single center retrospective study including preterm infants admitted to a level II unit (June 2019-2020). Close control of gas T&RH was implemented in Dec 2019 and consisted of starting with the heater at a set number higher than previously and followed by adjustments every 6 h based on intermittent temperature checks (target: 36.5°C-37°C). Humidity was controlled by adjusting the water level every 6 h and checking for the presence of condensation. Two groups were identified: infants treated with or without the close T&RH control. Primary outcome was the occurrence of nasal bleeding. Secondary outcomes were adherence to the policy, need to change the original mode of respiratory support or endotracheal intubation. Appropriate statistical tests were applied.<b>Results:</b> A total of 128 neonates were included: 63 managed without and 65 with close gas T&RH control. Rates of nasal bleeding decreased significantly with the close T&RH control, from 30% to 14% (<i>p</i> = 0.026) despite longer duration of non-invasive support (CPAP: 1.8 ± 1.9 vs 4.3 ± 5.8 days; <i>p</i> = 0.002 and NIPPV: 1.8 ± 1.4 vs 4.2 ± 5.2; <i>p</i> = 0.009). Adherence to the policy was 93%. Changes of the original mode of respiratory support also decreased significantly (14% vs 3%; 0.024) with no intubation.<b>Conclusion:</b> In the absence of advanced and expensive systems, a simple and low-cost intervention to optimize gas T&RH during non-invasive respiratory support in LMIC is feasible and associated with clinical improvements.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"19345798241291348"},"PeriodicalIF":0.9000,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Optimized control of gas temperature and relative humidity during non-invasive respiratory support in preterm infants: A simple and low-cost intervention.\",\"authors\":\"Karina Segatto, Renata Monteiro Weigert, Mariane Ferreira da Silveira, Fabiano Frâncio, Kelen Salvagni, Simone Caldeira Silva, Sergio Tadeu Martins Marba, Guilherme Sant'Anna\",\"doi\":\"10.1177/19345798241291348\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> During non-invasive respiratory support, administration of gases at high flow rates requires proper air conditioning to avoid upper airways complications. However, closed-loop control of temperature & relative humidity (T&RH) of mixed gases systems with wired-heated circuits are not commonly available in low-middle income countries (LMIC). Thus, a policy for close control of gas T&RH to overcome our system limitations was implemented. The objective of this study was to evaluate the impact of this intervention.<b>Method:</b> Single center retrospective study including preterm infants admitted to a level II unit (June 2019-2020). Close control of gas T&RH was implemented in Dec 2019 and consisted of starting with the heater at a set number higher than previously and followed by adjustments every 6 h based on intermittent temperature checks (target: 36.5°C-37°C). Humidity was controlled by adjusting the water level every 6 h and checking for the presence of condensation. Two groups were identified: infants treated with or without the close T&RH control. Primary outcome was the occurrence of nasal bleeding. Secondary outcomes were adherence to the policy, need to change the original mode of respiratory support or endotracheal intubation. Appropriate statistical tests were applied.<b>Results:</b> A total of 128 neonates were included: 63 managed without and 65 with close gas T&RH control. Rates of nasal bleeding decreased significantly with the close T&RH control, from 30% to 14% (<i>p</i> = 0.026) despite longer duration of non-invasive support (CPAP: 1.8 ± 1.9 vs 4.3 ± 5.8 days; <i>p</i> = 0.002 and NIPPV: 1.8 ± 1.4 vs 4.2 ± 5.2; <i>p</i> = 0.009). Adherence to the policy was 93%. Changes of the original mode of respiratory support also decreased significantly (14% vs 3%; 0.024) with no intubation.<b>Conclusion:</b> In the absence of advanced and expensive systems, a simple and low-cost intervention to optimize gas T&RH during non-invasive respiratory support in LMIC is feasible and associated with clinical improvements.</p>\",\"PeriodicalId\":16537,\"journal\":{\"name\":\"Journal of neonatal-perinatal medicine\",\"volume\":\" \",\"pages\":\"19345798241291348\"},\"PeriodicalIF\":0.9000,\"publicationDate\":\"2024-11-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of neonatal-perinatal medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/19345798241291348\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neonatal-perinatal medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19345798241291348","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
背景:在无创呼吸支持过程中,高流量气体的管理需要适当的空调以避免上呼吸道并发症。然而,具有线加热电路的混合气体系统的温度和相对湿度(T&RH)的闭环控制在中低收入国家(LMIC)并不常见。因此,我们实施了一项严格控制气体T&RH的政策,以克服我们的系统局限性。本研究的目的是评估这种干预措施的影响。方法:纳入2019年6月-2020年6月入住二级病房的早产儿的单中心回顾性研究。2019年12月实施了对燃气T&RH的严格控制,包括从加热器开始设置比以前更高的数值,然后根据间歇温度检查每6小时调整一次(目标:36.5°C-37°C)。湿度是通过每6小时调整一次水位和检查是否有冷凝来控制的。确定了两组:接受或不接受密切T&RH对照治疗的婴儿。主要结局为鼻出血的发生。次要结局为是否遵守政策,是否需要改变原有的呼吸支持模式或气管插管。采用了适当的统计检验。结果:共纳入128例新生儿:无气体T&RH对照63例,密闭气体T&RH对照65例。尽管无创支持持续时间较长(CPAP: 1.8±1.9 vs 4.3±5.8天),但严密控制T&RH后鼻出血率显著降低,从30%降至14% (p = 0.026);p = 0.002, NIPPV: 1.8±1.4 vs 4.2±5.2;P = 0.009)。该政策的依从率为93%。原始呼吸支持模式的改变也显著减少(14% vs 3%;0.024),未插管。结论:在缺乏先进和昂贵的系统的情况下,采用简单、低成本的干预措施优化LMIC无创呼吸支持期间的气体T&RH是可行的,并且与临床改善有关。
Optimized control of gas temperature and relative humidity during non-invasive respiratory support in preterm infants: A simple and low-cost intervention.
Background: During non-invasive respiratory support, administration of gases at high flow rates requires proper air conditioning to avoid upper airways complications. However, closed-loop control of temperature & relative humidity (T&RH) of mixed gases systems with wired-heated circuits are not commonly available in low-middle income countries (LMIC). Thus, a policy for close control of gas T&RH to overcome our system limitations was implemented. The objective of this study was to evaluate the impact of this intervention.Method: Single center retrospective study including preterm infants admitted to a level II unit (June 2019-2020). Close control of gas T&RH was implemented in Dec 2019 and consisted of starting with the heater at a set number higher than previously and followed by adjustments every 6 h based on intermittent temperature checks (target: 36.5°C-37°C). Humidity was controlled by adjusting the water level every 6 h and checking for the presence of condensation. Two groups were identified: infants treated with or without the close T&RH control. Primary outcome was the occurrence of nasal bleeding. Secondary outcomes were adherence to the policy, need to change the original mode of respiratory support or endotracheal intubation. Appropriate statistical tests were applied.Results: A total of 128 neonates were included: 63 managed without and 65 with close gas T&RH control. Rates of nasal bleeding decreased significantly with the close T&RH control, from 30% to 14% (p = 0.026) despite longer duration of non-invasive support (CPAP: 1.8 ± 1.9 vs 4.3 ± 5.8 days; p = 0.002 and NIPPV: 1.8 ± 1.4 vs 4.2 ± 5.2; p = 0.009). Adherence to the policy was 93%. Changes of the original mode of respiratory support also decreased significantly (14% vs 3%; 0.024) with no intubation.Conclusion: In the absence of advanced and expensive systems, a simple and low-cost intervention to optimize gas T&RH during non-invasive respiratory support in LMIC is feasible and associated with clinical improvements.