Respiratory function monitoring during resuscitation of extremely preterm infants: An ancillary study to the SAIL trial

项目总结/摘要 肺通气是早产儿出生后为了生存而实现的最关键的生理任务。然而 早产儿肺通气的最佳方法仍然未知。出生后，新生儿必须迅速打开 肺以清除胎儿肺液并建立功能残气量（FRC）。有两 实现这一目标的策略：间歇正压通气（IPPV）， 压力（PEEP）和持续充气（SI）。目前尚不清楚哪种策略对肺通气上级 出生后此外，执行非侵入性（即，面罩）呼吸支持在技术上是困难的， 早产儿常见问题的影响，如面罩泄漏和气道阻塞，对需要 用于抢救气管插管的情况不详。 本项目的目的是（1）评估SI和IPPV对肺通气直接测量的影响， 以及（2）确定所测量的呼吸力学的影响，例如面罩泄漏，气道阻塞， 和输送潮气量，在产房期间极早产儿需要抢救插管时 复苏术 为了实现这些目标，本提案将使用呼吸功能监测仪（RFM）直接测量 早产儿在产房复苏期间的肺通气指标。RFM是一项新颖的研究， 测量和显示真实的实时输送充盈的呼吸特征的工具。本项目为 SAIL试验的辅助研究（婴儿肺的持续通气，Clinicaltrials.gov标识符NCT 02139800）， 一项正在进行的SI与IPPV作为初始肺通气策略的国际随机对照试验， 极早产儿 RFM是一种用于在产房复苏期间测量肺力学的创新工具。SAIL试验 将是迄今为止在极早产儿中进行的SI与IPPV的最大随机试验。这 该项目将利用现有的SAIL试验框架，并使用RFM来确定最佳方法， 出生后给早产儿的肺通气。

PROJECT SUMMARY/ABSTRACT Lung aeration is the most critical physiologic task for the preterm infant to achieve after birth for survival. Yet the optimal method of aerating the preterm lung remains unknown. After birth, the newborn must rapidly open the lungs to clear the fetal lung liquid and establish a Functional Residual Capacity (FRC). There are two strategies to achieve this goal: Intermittent Positive Pressure Ventilation (IPPV) with positive end expiratory pressure (PEEP), and Sustained inflation (SI). It is not yet known which strategy is superior for lung aeration after birth. Further, performing non-invasive (i.e., facemask) respiratory support is technically difficult in preterm infants. The impact of common problems, such as facemask leak and airway obstruction, on the need for rescue endotracheal intubation is unknown. The objectives of this project are to (1) assess the effect of SI and IPPV on direct measures of lung aeration, and (2) to determine the impact of measured respiratory mechanics, such as mask leak, airway obstruction, and delivered tidal volumes, on need for rescue intubation in extremely preterm infants during delivery room resuscitation. To accomplish these objectives, this proposal will use a respiratory function monitor (RFM) to directly measure indicators of lung aeration in preterm infants during delivery room resuscitation. A RFM is a novel research tool that measures and displays respiratory characteristics of delivered inflations in real time. This project is an ancillary study of the SAIL trial (Sustained Aeration of Infant Lungs, Clinicaltrials.gov identifier NCT02139800), an ongoing international randomized controlled trial of SI versus IPPV as the initial lung aeration strategy in extremely preterm infants. RFM is an innovative tool to measure pulmonary mechanics during delivery room resuscitation. The SAIL trial will be the largest randomized trial of SI versus IPPV performed in extremely preterm infants to date. This project will take advantage of the existing SAIL trial framework and use RFM to identify the optimal approach to aerate the preterm lung after birth.