Use of ventilation/perfusion mismatch to guide individualised CPAP level selection in preterm infants: a feasibility trial.
Use of ventilation/perfusion mismatch to guide individualised CPAP level selection in preterm infants: a feasibility trial.
复制标题
使用通气/灌注不匹配来指导早产儿个体化 CPAP 水平选择：可行性试验。
DOI：
10.1136/archdischild-2022-324474
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Kirpalani,Haresh
中科院分区：
文献类型：
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作者：
Bamat,NicolasA;Orians,CarolynM;Abbasi,Soraya;Morley,ColinJ;RossRussell,Rob;Panitch,HowardB;Handley,SaraC;Foglia,ElizabethE;Posencheg,MichaelA;Kirpalani,Haresh
目的测量个体化经鼻持续气道正压通气（CPAP）水平选择方案对受试者通气/灌注（V′/Q′）不匹配的影响。设计单臂、非随机、可行性试验。地点费城儿童医院新生儿护理网络的三个中心。患者12名早产儿，经后年龄27-35周，出生后年龄>24小时，在4-7 cm H2O的CPAP上接受吸入氧分数（FiO 2）>0.25。干预我们应用了逐步CPAP水平变化的方案，总体方向和幅度由V′/Q′不匹配的个体反应指导，如通过无创气体交换模型中的右移程度（千帕，kPa）确定的。最佳CPAP水平被定义为V′/Q′改善超过5%的最终压力水平。主要结果测量基线和最佳CPAP水平之间V′/Q′不匹配的受试者内变化。结果基线和最佳CPAP水平之间V′/Q′不匹配的受试者内中位数（IQR）降低1.2（0-3.2）kPa，p=0.02。最佳CPAP的中位数（范围）绝对水平为7（5-8）cm H2O.ConclusionsNon-invasive措施的V′/Q′不匹配可能是一个有用的方法来确定个体化CPAP水平在早产儿。我们的可行性研究的结果应谨慎解释，并在更大的研究中重复评估这种方法对临床结果的影响是必要的。
ObjectiveTo measure within-subject changes in ventilation/perfusion (V′/Q′) mismatch in response to a protocol of individualised nasal continuous positive airway pressure (CPAP) level selection.DesignSingle-arm, non-randomised, feasibility trial.SettingThree centres in the Children’s Hospital of Philadelphia neonatal care network.PatientsTwelve preterm infants of postmenstrual age 27–35 weeks, postnatal age >24 hours, and receiving a fraction of inspired oxygen (FiO2) >0.25 on CPAP of 4–7 cm H2O.InterventionsWe applied a protocol of stepwise CPAP level changes, with the overall direction and magnitude guided by individual responses in V′/Q′ mismatch, as determined by the degree of right shift (kilopascals, kPa) in a non-invasive gas exchange model. Best CPAP level was defined as the final pressure level at which V′/Q′ improved by more than 5%.Main outcome measuresWithin-subject change in V′/Q′ mismatch between baseline and best CPAP levels.ResultsThere was a median (IQR) within-subject reduction in V′/Q′ mismatch of 1.2 (0–3.2) kPa between baseline and best CPAP levels, p=0.02. Best CPAP was observed at a median (range) absolute level of 7 (5–8) cm H2O.ConclusionsNon-invasive measures of V′/Q′ mismatch may be a useful approach for identifying individualised CPAP levels in preterm infants. The results of our feasibility study should be interpreted cautiously and replication in larger studies evaluating the impact of this approach on clinical outcomes is needed.Trial registration numberNCT02983825.