Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room
Impact of delivered tidal volume on the occurrence of intraventricular haemorrhage in preterm infants during positive pressure ventilation in the delivery room
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DOI：
10.1136/archdischild-2017-313864
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发表时间：
2019-01-01
影响因子：
4.4
通讯作者：
Schmolzer, Georg M.
中科院分区：
文献类型：
--
作者：
Mian, Qaasim;Cheung, Po-Yin;Schmolzer, Georg M.
背景和目的在产房正压通气（PPV）期间，意外的高潮气量（V-T）输送是常见的。在动物模型中，PPV期间的高V-T输送与血流动力学脑损伤相关。我们研究了出生时PPV期间V-T分娩是否与早产儿脑损伤相关，< 29 wk 'pregnancy.Methods在面罩和通气装置之间放置流量传感器。将V-T值与最近描述的出生时自主呼吸早产儿V-T参考范围进行比较。将婴儿分为V-T < 6 mL/kg或V-T > 6 mL/kg（分别为正常和高V-T）两组。结果165例早产儿中，124例（75%）V-T增高，41例（25%）V-T正常。高V-T组和正常V-T组的平均（SD）胎龄和出生体重相似，分别为26（2）和26（1）周，858（251）g和915（250）g。高V-T组IVH发生率为51%（63/63），正常V-T组IVH发生率为13%（5/53），两组比较差异有统计学意义（P= 0.008）。高V-T组中33/124例（27%）发生重度IVH（Ⅲ ~ Ⅳ度），而正常V-T组中2/41例（6%）发生重度IVH（P= 0.01）。应采用面罩PPV期间限制V-T输送的策略，以防止高V-T输送。
Background and objectives Delivery of inadvertent high tidal volume (V-T) during positive pressure ventilation (PPV) in the delivery room is common. High V-T delivery during PPV has been associated with haemodynamic brain injury in animal models. We examined if V-T delivery during PPV at birth is associated with brain injury in preterm infants < 29 weeks' gestation.Methods A flow-sensor was placed between the mask and the ventilation device. V-T values were compared with recently described reference ranges for V-T in spontaneously breathing preterm infants at birth. Infants were divided into two groups: V-T < 6 mL/kg or V-T > 6 mL/kg (normal and high V-T, respectively). Brain injury (eg, intraventricular haemorrhage (IVH)) was assessed using routine ultrasound imaging within the first days after birth.Results A total of 165 preterm infants were included, 124 (75%) had high V-T and 41 (25%) normal V-T. The mean (SD) gestational age and birth weight in high and normal V-T group was similar, 26 (2) and 26 (1) weeks, 858 (251) g and 915 (250) g, respectively. IVH in the high V-T group was diagnosed in 63 (51%) infants compared with 5 (13%) infants in the normal V-T group (P= 0.008). Severe IVH (grade III or IV) developed in 33/124 (27%) infants in the high V-T group and 2/41 (6%) in the normal V-T group (P= 0.01).Conclusions High V-T delivery during mask PPV at birth was associated with brain injury. Strategies to limit V-T delivery during mask PPV should be used to prevent high V-T delivery.