Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data.
Defining Optimal Head-Tilt Position of Resuscitation in Neonates and Young Infants Using Magnetic Resonance Imaging Data.
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DOI：
10.1371/journal.pone.0151789
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Acharya S
中科院分区：
文献类型：
--
作者：
Bhalala US;Hemani M;Shah M;Kim B;Gu B;Cruz A;Arunachalam P;Tian E;Yu C;Punnoose J;Chen S;Petrillo C;Brown A;Munoz K;Kitchen G;Lam T;Bosemani T;Huisman TA;Allen RH;Acharya S
头部倾斜动作有助于在复苏过程中实现气道通畅。然而，头部倾斜角度和气道通畅之间的关系尚未确定。我们的目的是确定新生儿（年龄：0-28天）和小婴儿（年龄：29天-4个月）气道通畅的最佳头部倾斜位置。我们对新生儿和婴儿的头部和颈部磁共振成像（MRI）进行了回顾性研究，以确定呼吸道通畅的头部倾斜角度。我们排除了那些有人工气道或气道畸形的患者。我们先验地将头部倾斜角定义为矢状位MR图像上枕颈-颅顶线与颅顶-C7棘突线之间的角度。我们评估了MRI期间缺氧缺血性脑病（HIE）和镇静暴露的病历。本文分析了63例小儿（新生儿53例，婴幼儿10例）头颈部MRI表现。在这63名儿童中，17名有气道阻塞的证据，46名在MRI上有气道通畅。此外，16/63例有基础HIE，47/63例新生儿在MRI期间暴露于镇静药物。在自主呼吸和神经系统抑郁的新生儿中，与气道通畅（125.3° ± 11.9°）相关的头部倾斜角（中位数± SD）与气道阻塞（108.2° ± 17.1°）相关的头部倾斜角（中位数± SD）显著不同（Mann Whitney U检验，p = 0.0045）。Logistic回归分析显示，随着头倾角的增加，气道通畅的比例逐渐增加，头倾角144-150°时气道通畅的概率> 95%。
Head-tilt maneuver assists with achieving airway patency during resuscitation. However, the relationship between angle of head-tilt and airway patency has not been defined. Our objective was to define an optimal head-tilt position for airway patency in neonates (age: 0–28 days) and young infants (age: 29 days–4 months). We performed a retrospective study of head and neck magnetic resonance imaging (MRI) of neonates and infants to define the angle of head-tilt for airway patency. We excluded those with an artificial airway or an airway malformation. We defined head-tilt angle a priori as the angle between occipito-ophisthion line and ophisthion-C7 spinous process line on the sagittal MR images. We evaluated medical records for Hypoxic Ischemic Encephalopathy (HIE) and exposure to sedation during MRI. We analyzed MRI of head and neck regions of 63 children (53 neonates and 10 young infants). Of these 63 children, 17 had evidence of airway obstruction and 46 had a patent airway on MRI. Also, 16/63 had underlying HIE and 47/63 newborn infants had exposure to sedative medications during MRI. In spontaneously breathing and neurologically depressed newborn infants, the head-tilt angle (median ± SD) associated with patent airway (125.3° ± 11.9°) was significantly different from that of blocked airway (108.2° ± 17.1°) (Mann Whitney U-test, p = 0.0045). The logistic regression analysis showed that the proportion of patent airways progressively increased with an increasing head-tilt angle, with > 95% probability of a patent airway at head-tilt angle 144–150°.