Hemodynamics and gas exchange during chest compressions in neonatal resuscitation.
Hemodynamics and gas exchange during chest compressions in neonatal resuscitation.
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DOI：
10.1371/journal.pone.0176478
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Lakshminrusimha S
中科院分区：
文献类型：
--
作者：
Vali P;Chandrasekharan P;Rawat M;Gugino S;Koenigsknecht C;Helman J;Mathew B;Berkelhamer S;Nair J;Wyckoff M;Lakshminrusimha S
在胎儿分流和充满液体的肺泡的过渡胎儿循环模型中，目前对新生儿复苏期间肺/全身血流动力学和气体交换的了解有限。利用胎羊窒息模型，我们试图确定血流动力学或气体交换参数是否能预测自主循环的成功恢复(ROSC)。在22只羔羊中阻断脐带以诱导窒息心脏骤停。在5分钟的停搏后，根据AHA-新生儿复苏计划指南开始复苏。在复苏过程中评估血流动力学参数和系列动脉血气。18只羔羊(82%)发生ROSC，平均IQR时间为120秒(105-180秒)。在基线和复苏过程中的任何给定时间点，在获得ROSC的羔羊和没有获得ROSC的羔羊之间，血流动力学参数没有差异。复苏前被捕时的血气在两组之间是相似的。然而，获得ROSC的羔羊在复苏过程中PaO2较低，PaCO2较高，乳酸较低。在获得ROSC的羔羊中，肾上腺素引起的舒张压升高(11±4 mm Hg)与未复苏的羔羊(10±6 mm Hg)没有差别。较低的舒张压足以实现ROSC。新生羔羊窒息模型的血流动力学参数不能预测ROSC的成功。在未达到ROSC的羔羊中观察到的乳酸酸中毒、较高的PaO2和较低的PaCO2可能代表组织灌注量不足和/或线粒体功能障碍。
Current knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluid-filled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC). The umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation. ROSC occurred in 18 lambs (82%) at a median (IQR) time of 120 (105–180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 ±4 mmHg) did not differ from those that were not resuscitated (10 ±6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC. Hemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.