Optimal Inspired Oxygen during Chest Compressions in Neonatal Resuscitation

新生儿复苏胸外按压期间的最佳吸入氧气

基本信息

批准号：
10322032
负责人：
Munmun Rawat
金额：
$ 7.98万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-01-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10322032
关键词：
3-nitrotyrosine Accounting Acidosis Adult Advocate Alveolar Asphyxia Asphyxia Neonatorum Biochemical Birth Blinded Blood Blood Circulation Blood flow Blood gas Bradycardia Brain Cardiopulmonary Resuscitation Carotid Arteries Cause of Death Cerebrum Chest Coronary Data Delivery Rooms Drops Duct (organ) structure Equilibrium Expert Opinion Fetal Sheep Future Gases Glutathione Disulfide Goals Guidelines Heart Heart Arrest Homeostasis Human Incidence Induced Heart Arrest Infant International Investigation Isoprostanes Lead Literature Lung Masks Modeling Monitor Morbidity - disease rate Myocardial Myocardial perfusion Neurologic Newborn Infant Outcome Oxidative Stress Oxygen Oxygen Therapy Care Partial Pressure Perfusion Perinatal Physiological Process Pulmonary Vascular Resistance Randomized Reactive Oxygen Species Recommendation Reperfusion Injury Research Rest Resuscitation Risk Severities Superoxides Time Tissues Umbilical cord structure Weaning base cerebral oxygenation clinical care coronary perfusion delivery complications hemodynamics hypoxic ischemic injury improved innovation lamb model mortality neonatal death neonatal resuscitation neonate oxidative damage oxygen toxicity pressure programs randomized controlled study supplemental oxygen ventilation

项目摘要

ABSTRACT Birth asphyxia is a global issue accounting for about 23% of approximately 2.5 million neonatal deaths each year. These asphyxiated newly born infants require extensive resuscitation including chest compressions (CC) in the delivery room, and suffer from high mortality and neurologic morbidity. The optimal oxygen (O2) concentration during CC in an asphyxiated newborn is not known. The recommendation by the Neonatal Resuscitation Program (NRP) to provide 100% inspired O2 during CC is based on indirect evidence and expert opinion which has shown to cause oxidative injury. On the other hand, ventilation with 21% O2 could lead to inadequate oxygenation resulting in delayed pulmonary transition and elevated pulmonary vascular resistance (PVR) which may further extend the window of hypoxic-ischemic injury. An intermediate O2 concentration (inspired O2 of 50%) could balance these two competing processes and maintaining homeostasis after severe hypoxic-ischemic injury in cardiac arrest. In this proposal we plan to determine the optimal inspired O2 (21%, 50% or 100%) during CC using a randomized, masked study that optimizes oxygen delivery to the brain and heart leading to early return of spontaneous circulation with minimal oxidative stress in perinatal lambs with perinatal asphyxia-induced cardiac arrest. To accomplish this 21 term fetal lambs will be asphyxiated by umbilical cord occlusion resulting in cardiac arrest. Lambs will be randomized to 3 groups: Inspired oxygen of 21%, 50% and 100% during CC and rest of the resuscitation steps will follow the NRP guidelines. Blood gases and hemodynamic parameters will be continuously monitored. Lambs will be resuscitated for 20 minutes or till the ROSC is achieved, whichever is earlier. At the end of 20 minutes, lambs will be euthanized and tissues will be collected for oxidative stress markers. In this way, we can compare physiologic changes and the resultant oxidative stress markers to better understand what may be happening during the resuscitation of an asphyxiated human newborn. Relevance to current practice in neonatal resuscitation: Despite a lack of scientific evidence, supplemental oxygen has been used in neonatal resuscitation for more than 200 years. There is a growing demand to resolve the controversy on oxygen therapy during resuscitation of term asphyxiated infants in cardiac arrest. The studies proposed in this application are likely to provide physiologic and biochemical data to aid in determining the optimal inspired oxygen during CC and eventually refine neonatal resuscitation guidelines and may reduce the burden of birth complications.

抽象的出生窒息是一个全球问题，约占250万新生儿死亡的23％每年。这些窒息的新生婴儿需要广泛的复苏，包括胸部分娩室中的压缩（CC），并患有高死亡率和神经系统发病率。这在窒息新生儿中CC期间的最佳氧（O2）浓度尚不清楚。这新生儿复苏计划（NRP）的建议在CC期间提供100％启发的O2 基于间接证据和专家意见，已证明会导致氧化损伤。另一方面手，21％O2的通风可能导致氧合不足，导致肺部延迟过渡和升高的肺血管耐药性（PVR），可以进一步扩展缺氧缺血性损伤。中级O2浓度（启发的O2为50％）可以平衡这两个心脏骤停严重缺氧 - 缺血性损伤后，竞争过程并保持体内平衡。在此提案中，我们计划使用A期间确定最佳启发的O2（21％，50％或100％）随机，掩盖的研究，优化向大脑递送的氧气和心脏，导致早期回归在围产期羔羊中具有最小氧化应激的自发循环，围产期窒息诱导心脏停搏。为了完成这个21个任期的胎儿羔羊，将被脐带遮挡窒息，导致心脏逮捕。羔羊将随机分为3组：CC和休息期间的21％，50％和100％的启发氧复苏步骤将遵循NRP指南。血液气体和血液动力学参数将不断监控。羔羊将复苏20分钟或直到达到ROSC为止，以较早的方式。在20分钟结束时，羔羊将被安乐死，并收集组织氧化应激标记。这样，我们可以比较生理变化和所得的氧化。应力标记以更好地了解窒息的复苏期间可能发生的事情人类新生儿。与新生儿复苏中的当前实践有关：尽管缺乏科学证据，但已在新生儿复苏中使用了补充氧超过200年。在解决关于氧疗法的争议期间的需求日益增长心脏骤停中窒息婴儿的术语复苏。该应用中提出的研究是可能提供生理和生化数据，以帮助确定最佳的氧气 CC并最终完善新生儿复苏指南，并可能减轻出生负担并发症。