Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model
Effect of various inspired oxygen concentrations on pulmonary and systemic hemodynamics and oxygenation during resuscitation in a transitioning preterm model
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DOI：
10.1038/s41390-018-0085-x
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发表时间：
2018-11-01
影响因子：
3.6
通讯作者：
Lakshminrusimha, Satyan
中科院分区：
文献类型：
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作者：
Chandrasekharan, Praveen;Rawat, Munmun;Lakshminrusimha, Satyan
背景：新生儿复苏计划建议对早产儿在低氧(O-2)的情况下进行初始复苏，然后滴定至目标还原饱和度(SPO(2))。方法：29只妊娠127d的早产羔羊随机分为3组，每组6只，分别为21%氧复苏组(n=7)、100%氧复苏组(n=6)、21%氧复苏组(n=6)和21%氧复苏组(n=16)。用21%O-2对7只健康足月羔羊进行呼吸试验。结果：在21%O-2条件下，P还原SpO(2)的滴定范围与足月羔羊相似。用21%和100%O-2复苏早产羔羊，分别导致SpO(2)低于和高于目标。100%O-2组早产羔羊和21%O-2组足月羔羊肺血管阻力(PVR)明显降低。而21%O-2和滴定O-2的早产羔羊在21%O-2下的肺血管阻力显著高于足月羔羊。结论(S)：21%O-2复苏后滴定O-2可导致早产羔羊出生时的肺血管转移率低于正常早产羔羊。100%O-2对早产羔羊造成高氧，但降低PVR，与21%O-2的早产羔羊相似。评估早产儿在较高氧浓度下开始复苏，然后根据SpO(2)进行滴定的研究是必要的。
BACKGROUND: The Neonatal Resuscitation Program recommends initial resuscitation of preterm infants with low oxygen (O-2) followed by titration to target preductal saturations (SpO(2)). We studied the effect of resuscitation with titrated O-2 on gas exchange, pulmonary, and systemic hemodynamics.METHODOLOGY: Twenty-nine preterm lambs (127 d gestation) were randomized to resuscitation with 21% O-2 (n = 7), 100% O-2 (n = 6), or initiation at 21% and titrated to target SpO(2) (n = 16). Seven healthy term control lambs were ventilated with 21% O-2.RESULTS: Preductal SpO(2) achieved by titrating O-2 was within the desired range similar to term lambs in 21% O-2. Resuscitation of preterm lambs with 21% and 100% O-2 resulted in SpO(2) below and above the target, respectively. Ventilation of preterm lambs with 100% O-2 and term lambs with 21% O-2 effectively decreased pulmonary vascular resistance (PVR). In contrast, preterm lambs with 21% O-2 and titrated O-2 demonstrated significantly higher PVR than term lambs on 21% O-2.CONCLUSION(S): Initial resuscitation with 21% O-2 followed by titration of O-2 led to suboptimal pulmonary vascular transition at birth in preterm lambs. Ventilation with 100% O-2 in preterm lambs caused hyperoxia but reduced PVR similar to term lambs on 21% O-2. Studies evaluating the initiation of resuscitation at a higher O-2 concentration followed by titration based on SpO(2) in preterm neonates are needed.