Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room
Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room
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DOI：
10.1136/adc.2010.191171
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发表时间：
2011-07-01
影响因子：
4.4
通讯作者：
Davis, Peter G.
中科院分区：
文献类型：
--
作者：
Schmoelzer, Georg M.;Dawson, Jennifer A.;Davis, Peter G.
前言呼吸不足的早产儿通过面罩接受正压通气（PPV），成功率各不相同。作者检查了在产房给予早产儿的PPV记录，以了解面罩泄漏和气道阻塞的患病率。方法和患者作者回顾了2006年2月至2009年3月出生的妊娠< 32周的婴儿的记录。PPV使用T型或自充气袋和圆形硅胶面罩输送。用呼吸功能监测仪（RFM）记录气道压力和气体流量。从网络摄像头记录的视频被用来审查复苏。分析每例婴儿的前2分钟PPV。结果本组56例早产儿的呼吸机监测结果显示，呼吸机通气量（V-Te）下降75%为呼吸道阻塞，呼吸机面罩漏气> 75%为呼吸道漏气。14例（26%）记录发生阻塞，27例（51%）记录发生泄漏。在8例（14%）记录中观察到阻塞和面罩泄漏，在15例（27%）记录中未观察到阻塞和面罩泄漏。阻塞发生在PPV开始后中位数（IQR）48（24-60）s。进行了中位（范围）22次（3-83次）连续阻塞性充盈。19/27例（70%）在首次充盈时发生面罩泄漏，其余8例在PPV开始后中位数（IQR）30（24-46）s时发生面罩泄漏。平均连续充气10次（3-117次），漏气率> 75%。结论气道阻塞和面罩漏气在PPV开始的2 min内较为常见。RFM能够检测重要的气道阻塞和面罩泄漏。
Introduction Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction.Methods and patients The authors reviewed recordings of infants at < 32 weeks' gestation born between February 2006 and March 2009. PPV was delivered with a T-piece or self-inflating bag and a round silicone face mask. Airway pressures and gas flow were recorded with a respiratory function monitor (RFM). Videos recorded from a web camera were used to review the resuscitation. The first 2 min of PPV were analysed for each infant. Obstruction was arbitrarily defined as a 75% reduction in delivered expired tidal volume (V-Te) and significant face-mask leak as > 75%.Results The authors analysed recordings of 56 preterm infants. Obstruction occurred in 14 (26%) recordings and leaks in 27 (51%). Both obstruction and mask leaks were seen in eight (14%) recordings, and neither was seen in 15 (27%). Obstruction occurred at a median (IQR) of 48 (24-60) s after the start of PPV. A median (range) of 22 (3-83) consecutive obstructed inflations were delivered. Face-mask leaks occurred from the first inflation in 19/27 (70%) and in the remaining eight at a median (IQR) of 30 (24-46) s after the start of PPV. A median (range) of 10 (3-117) consecutive inflations with a leak > 75% were delivered.Conclusion Airway obstruction and face-mask leak are common during the first 2 min of PPV. An RFM enables detection of important airway obstruction and mask leak.