Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord.
Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord.
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DOI：
10.3390/children8050353
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发表时间：
2021-04-29
期刊：
影响因子：
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通讯作者：
Lakshminrusimha S
中科院分区：
文献类型：
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作者：
Nair J;Davidson L;Gugino S;Koenigsknecht C;Helman J;Nielsen L;Sankaran D;Agrawal V;Chandrasekharan P;Rawat M;Berkelhamer SK;Lakshminrusimha S
窒息时夹住脐带的最佳时机尚不清楚。我们的目的是确定早期(ECC)或延迟夹脐带(DCC)对近期窒息羔羊的呼吸机(持续充气-SI与正压通气-V)的效果。我们推测，SI加DCC可改善近期窒息缓慢性羊群的气体交换和血流动力学。共有28只羔羊被窒息，平均血压为22毫米汞柱。将羔羊随机分为5组：体外循环+V组、体外循环+SI组、体外循环+V组、顺行+V组和顺行+插管+SI组。用生物素标记的红细胞评估胎盘输血的大小。采用窒息心动过缓模型，每组2~3只羔羊。两组患者的主要预后、达到基线颈动脉血流量的时间、HR≥为100次/分或血压≥为40毫米汞柱均无差异。SI可减少肺(PBF)和脐静脉(UV)血流量，但不影响CBF和脐动脉血流量。伴有SI的PBF在出生后几分钟内持续显著下降。在我们的围产期窒息模型中，最初的SI呼吸增加了呼吸道压力，减少了PBF和紫外线返回，脐带完整。有必要进行进一步的临床研究，评估窒息婴儿的脐带夹闭时机和呼吸策略。
The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted.