Use of ventilation/perfusion mismatch to guide individualised CPAP level selection in preterm infants: a feasibility trial.
Arch Dis Child Fetal Neonatal Ed
; 108(2): 188-193, 2023 Mar.
Article
em En
| MEDLINE
| ID: mdl-36104165
ABSTRACT
OBJECTIVE:
To measure within-subject changes in ventilation/perfusion (V'/Q') mismatch in response to a protocol of individualised nasal continuous positive airway pressure (CPAP) level selection.DESIGN:
Single-arm, non-randomised, feasibility trial.SETTING:
Three centres in the Children's Hospital of Philadelphia neonatal care network. PATIENTS Twelve preterm infants of postmenstrual age 27-35 weeks, postnatal age >24 hours, and receiving a fraction of inspired oxygen (FiO2) >0.25 on CPAP of 4-7 cm H2O.INTERVENTIONS:
We applied a protocol of stepwise CPAP level changes, with the overall direction and magnitude guided by individual responses in V'/Q' mismatch, as determined by the degree of right shift (kilopascals, kPa) in a non-invasive gas exchange model. Best CPAP level was defined as the final pressure level at which V'/Q' improved by more than 5%. MAIN OUTCOMEMEASURES:
Within-subject change in V'/Q' mismatch between baseline and best CPAP levels.RESULTS:
There was a median (IQR) within-subject reduction in V'/Q' mismatch of 1.2 (0-3.2) kPa between baseline and best CPAP levels, p=0.02. Best CPAP was observed at a median (range) absolute level of 7 (5-8) cm H2O.CONCLUSIONS:
Non-invasive measures of V'/Q' mismatch may be a useful approach for identifying individualised CPAP levels in preterm infants. The results of our feasibility study should be interpreted cautiously and replication in larger studies evaluating the impact of this approach on clinical outcomes is needed. TRIAL REGISTRATION NUMBER NCT02983825.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Síndrome do Desconforto Respiratório do Recém-Nascido
/
Recém-Nascido Prematuro
Tipo de estudo:
Clinical_trials
/
Guideline
Limite:
Child
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Humans
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Infant
/
Newborn
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article