Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

Ericksen, Kristina; Alpan, Gad; Gamma, Edmund F. La

doi:10.1111/apa.15600

Cited by 4 publications

(8 citation statements)

References 30 publications

(49 reference statements)

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“…This finding confirms what was previously described by Ericksen and coworkers in a smaller population of 12 pre-term patients. 25 Peripheral SpO 2 levels remained substantially stable (i.e., between 91% and 95%) throughout the study period, demonstrating that the extubation maneuver was well tolerated. 31 There was no post-extubation brain bleeding event and we recorded only one case of failed extubation, which had no clinical consequences for the patient.…”

Section: Discussionmentioning

confidence: 77%

“…Such a brief time frame and a similar approach were already validated in other studies. 25 The chosen time frame was based on the best stability of the rScO 2 data (lower SD), greater availability of data, and best proximity to the extubation. Readings pertaining to the 15 min immediately before and after extubation were excluded from the current analysis ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study

Massirio,

Cardiello,

Andreato

et al. 2024

Neurotrauma Reports

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Early extubation is considered to be beneficial for pre-term neonates. On the other hand, premature extubation can cause lung derecruitment, compromised gas exchange, and need for reintubation, which may be associated with severe brain injury caused by sudden cerebral blood flow changes. We used near infrared spectroscopy (NIRS) to investigate changes in cerebral oxygenation (rScO 2 ) and fractional tissue oxygen extraction (+) after extubation in pre-term infants. This is a single-center retrospective study of NIRS data at extubation time of all consecutive pre-term neonates born at our institution over a 1-year period. Comparison between subgroups was performed. Nineteen patients were included; average gestational age (GA) was 29.4 weeks. No significant change was noted in rScO 2 and cFTOE after extubation in the whole population. GA and germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) showed a significant change in rScO 2 and cFTOE after extubation. A significant increase in cFTOE was noted in patients with previous GMH-IVH (+0.040; p = 0.05). To conclude, extubation per se was not associated with significant change in cerebral oxygenation and perfusion. Patients with a diagnosed GMH-IVH showed an increase in cFTOE, suggesting perturbation in cerebral perfusion suggesting further understanding during this challenging phenomenon. Larger studies are required to corroborate our findings.

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Section: Discussionmentioning

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study

Massirio,

Cardiello,

Andreato

et al. 2024

Neurotrauma Reports

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“…CBF and cerebral oxygenation measures are difficult in humans and ultrasound measures or Near-InfraRed Spectroscopy may be more translatable tools. (24,25) Assessment of cerebral flow dynamics was made via the common practice of measuring from a single carotid artery, (19,26) with occlusion of the other. Extrapolating these measures to global cerebral haemodynamics requires caution, as unilateral occlusion may result in changes to the flow dynamics of the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst this is common practice in lamb studies, 22,34 it is not possible in humans. Ultrasound measures or Near-InfraRed Spectroscopy have been used in humans, including preterm infants, to assess CBF and cerebral oxygenation, 35,36, 37 and may have aided translatability. Extrapolating unilateral carotid blood flow measures to global cerebral haemodynamics requires caution, as unilateral occlusion may result in changes to the flow dynamics of the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

Aeration Strategy at Birth Does Not Impact Carotid Haemodynamics in Preterm Lambs

Dahm

Kenna

Stewart

et al. 2022

Preprint

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ObjectiveTo examine the effect of three different ventilation strategies at birth on markers of cerebral haemodynamics and oxygenation.DesignAnimal research.SettingAnimal research facility.Subjects124-127 day gestation apnoeic preterm lambs (n=68) born via caesarean section.InterventionsLambs were randomised to either positive pressure ventilation with positive end-expiratory pressure (PEEP) 8 cmH2O (No-RM; n=12), sustained inflation (SI; n=15) or a dynamic PEEP strategy (DynPEEP; n=41) at birth, followed by 90 minutes of standardised ventilation. Prior to birth a carotid artery flow probe was placed, with occlusive cannulation of the contralateral carotid artery. Carotid blood flow, ventilation data, peripheral oxygen saturation (SpO2), heart rate and arterial blood pressure were continuously recorded, with intermittent arterial blood gas analysis at set time points.Main outcome measuresCarotid blood flow, carotid artery oxygen content and carotid oxygen delivery (product of carotid artery blood flow and oxygen content).ResultsOverall carotid blood flow measures were comparable between strategies. The exception being mean carotid blood flow during the first 3 minutes after birth, which was significantly lower for the SI group compared to the No-RM and DynPEEP groups respectively (p<0.0001; repeated-measure mixed effect ANOVA). Carotid arterial oxygen content (p=0.19) and oxygen delivery (p=0.50) were similar between strategies. Maximum PEEP did not alter cerebral haemodynamic measures.ConclusionsThis is the first study to compare cerebral haemodynamics during different PEEP strategies with SI at birth. Although there were some short-term variations, there were no sustained differences.What is already known on this topicFacilitating the respiratory transition at birth for preterm infants is essential for the lungs as well as the brain. Whilst our understanding of the impact of different respiratory strategies on the lungs is well understood, preclinical data involving other organs is sparse. Concerns have been raised that aggressive lung recruitment may impede cerebral haemodynamics in the preterm infant.What this study addsTo our knowledge, this is the first study that assesses the effect of the three different aeration strategies currently being considered in clinical practice; sustained inflation, dynamic and static positive end-expiratory pressure (PEEP), on cerebral haemodynamics. We found that differing ventilation strategies did not alter carotid blood flow, carotid oxygen content or carotid oxygen delivery. Specifically, there was no difference between sustained inflation (to 35 cmH2O) and maximum PEEP levels of 8, 14 and 20 cmll.O applied during the first three minutes after birth.How this study might affect research, practice or policyFollowing preterm birth it is important to consider the effect of ventilation strategies on other organs, especially the brain. This preclinical study provides some reassurance that respiratory strategies designed to focus on lung aeration at birth may not impact cerebral haemodynamics in preterm neonates.

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“…While this is common practice in lamb studies, 22,34 it is not possible in humans. Ultrasound measures near-infrared spectroscopy have been used in humans, including preterm infants, to assess CBF and cerebral oxygenation, [35][36][37] and may have aided translatability. Extrapolating unilateral carotid blood flow measures to global cerebral haemodynamics requires caution, as unilateral occlusion may result in changes to the flow dynamics of the contralateral side.…”

Section: Discussionmentioning

confidence: 99%

Aeration strategy at birth does not impact carotid haemodynamics in preterm lambs

et al. 2022

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Background The impact of different respiratory strategies at birth on the preterm lung is well understood; however, concerns have been raised that lung recruitment may impede cerebral haemodynamics. This study aims to examine the effect of three different ventilation strategies on carotid blood flow, carotid artery oxygen content and carotid oxygen delivery. Methods 124–127-day gestation apnoeic intubated preterm lambs studied as part of a larger programme primarily assessing lung injury were randomised to positive pressure ventilation with positive end-expiratory pressure (PEEP) 8 cmH2O (No-RM; n = 12), sustained inflation (SI; n = 15) or dynamic PEEP strategy (DynPEEP; maximum PEEP 14 or 20 cmH2O, n = 41) at birth, followed by 90 min of standardised ventilation. Haemodynamic data were continuously recorded, with intermittent arterial blood gas analysis. Results Overall carotid blood flow measures were comparable between strategies. Except for mean carotid blood flow that was significantly lower for the SI group compared to the No-RM and DynPEEP groups over the first 3 min (p < 0.0001, mixed effects model). Carotid oxygen content and oxygen delivery were similar between strategies. Maximum PEEP level did not alter cerebral haemodynamic measures. Conclusions Although there were some short-term variations in cerebral haemodynamics between different PEEP strategies and SI, these were not sustained. Impact Different pressure strategies to facilitate lung aeration at birth in preterm infants have been proposed. There is minimal information on the effect of lung recruitment on cerebral haemodynamics. This is the first study that compares the effect of sustained lung inflation and dynamic and static positive end-expiratory pressure on cerebral haemodynamics. We found that the different ventilation strategies did not alter carotid blood flow, carotid oxygen content or carotid oxygen delivery. This preclinical study provides some reassurance that respiratory strategies designed to focus on lung aeration at birth may not impact cerebral haemodynamics in preterm neonates.

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Effect of ventilator modes on neonatal cerebral and peripheral oxygenation using near‐infrared spectroscopy

Cited by 4 publications

References 30 publications

Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study

Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study

Aeration Strategy at Birth Does Not Impact Carotid Haemodynamics in Preterm Lambs

Aeration strategy at birth does not impact carotid haemodynamics in preterm lambs

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