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

项目摘要/摘要 肺充气是早产儿生后生存最关键的生理任务。还没有 使早产儿肺充气的最佳方法仍不清楚。出生后，新生儿必须迅速打开 清除肺内胎儿肺液，建立功能性残气量(FRC)。有两个 实现这一目标的策略：呼气末正压间歇通气(IPPV) 压力(PEEP)和持续通货膨胀(SI)。目前尚不清楚哪种肺充气策略更好。 出生后。此外，执行非侵入性(即，口罩)呼吸支持在技术上是困难的 早产儿。常见问题，如口罩泄漏和呼吸道阻塞，对需求的影响 对于抢救，气管内插管是未知的。 本项目的目标是(1)评估SI和IPPV对直接测量肺充气的影响， 以及(2)确定测量的呼吸力学的影响，例如口罩泄漏、呼吸道阻塞、 极早产儿产房需要抢救插管时的潮气量 复苏。 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肺充气的指标。RFM是一项新的研究 实时测量和显示所产生的充气的呼吸特征的工具。这个项目是一个 SAIL试验的辅助研究(婴儿肺的持续充气，ClinicalTrials.gov标识符NCT02139800)， 一项正在进行的将SI和IPPV作为初始肺充气策略的国际随机对照试验 极早产儿。 RFM是一种在产房复苏期间测量肺力学的创新工具。帆船试航 这将是迄今为止在极早产儿中进行的SI和IPPV的最大规模随机试验。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充气。

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.