Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants
Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants
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DOI：
10.1152/ajpgi.00307.2015
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发表时间：
2016-06-01
影响因子：
4.5
通讯作者：
Shaker, Reza
中科院分区：
文献类型：
--
作者：
Jadcherla, Sudarshan R.;Hasenstab, Kathryn A.;Shaker, Reza
咽部是患有呼吸消化疾病的婴儿的诱发部位，表现为吞咽困难、危及生命的事件、吸入性肺炎、肺不张和反流，此类婴儿通常接受鼻呼吸支持。我们确定了不同供氧方法对咽部刺激引起的呼吸消化反射[室内空气（RA）、鼻插管（NC）和鼻持续气道正压通气（nCPAP）]的影响，同时假设假定反射的感觉运动特征是不同的。 38 名婴儿（妊娠 28.0 +/- 0.7 周）接受了咽部食管测压和呼吸感应体积描记术，以确定分级咽部刺激 (n = 271) 对食管上、下括约肌 (UES、LES)、吞咽和吞咽呼吸暂停的影响。对 NC (n = 19)、nCPAP (n = 9) 和 RA (n = 10) 组进行比较。重要的是，NC 或 nCPAP（与 RA 相比）具有：1）喂养里程碑延迟（P < 0.05），2）咽部波形募集和持续时间增加，UES 最低压力更大，食管收缩持续时间减少，远端食管收缩幅度减少，完全传播的食管蠕动减少（所有 P < 0.05），3）类似的 UES 收缩和 LES 松弛反射（P > 0.05）。我们得出的结论是，使用无创呼吸支持以及充分的上、下呼吸消化保护的婴儿的呼吸消化反射也有类似的发展。在这一人群中，对胃食管反流病的日益关注是没有根据的。这些婴儿可能受益于有针对性的口腔运动喂养疗法和安全的咽部推注转运，以加速喂养里程碑。
The pharynx is a locus of provocation among infants with aerodigestive morbidities manifesting as dysphagia, life-threatening events, aspiration-pneumonia, atelectasis, and reflux, and such infants often receive nasal respiratory support. We determined the impact of different oxygen delivery methods on pharyngeal stimulation-induced aerodigestive reflexes [ room air (RA), nasal cannula (NC), and nasal continuous positive airway pressure (nCPAP)] while hypothesizing that the sensory motor characteristics of putative reflexes are distinct. Thirty eight infants (28.0 +/- 0.7 wk gestation) underwent pharyngoesophageal manometry and respiratory inductance plethysmography to determine the effects of graded pharyngeal stimuli (n = 271) on upper and lower esophageal sphincters (UES, LES), swallowing, and deglutition-apnea. Comparisons were made between NC (n = 19), nCPAP (n = 9), and RA (n = 10) groups. Importantly, NC or nCPAP (vs. RA) had: 1) delayed feeding milestones (P < 0.05), 2) increased pharyngeal waveform recruitment and duration, greater UES nadir pressure, decreased esophageal contraction duration, decreased distal esophageal contraction amplitude, and decreased completely propagated esophageal peristalsis (all P < 0.05), and 3) similarly developed UES contractile and LES relaxation reflexes (P > 0.05). We conclude that aerodigestive reflexes were similarly developed in infants using noninvasive respiratory support with adequate upper and lower aerodigestive protection. Increased concern for GERD is unfounded in this population. These infants may benefit from targeted oromotor feeding therapies and safe pharyngeal bolus transit to accelerate feeding milestones.