Lung volume distribution in preterm infants on non-invasive high-frequency ventilation

Gaertner, Vincent D.; Waldmann, Andreas D.; Davis, Peter G; Bassler, Dirk; Springer, Laila; Thomson, Jessica; Tingay, David G.; Rüegger, Christoph M.

doi:10.1136/archdischild-2021-322990

Cited by 8 publications

(11 citation statements)

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“…Supraglottic application of nasal HFOV (nHFOV) is used in some centres in Europe [116] and is the subject of ongoing research [117]. The oscillations are apparently transmitted all the way down to the lungs [118].…”

Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of “European Guidelines for the Management of RDS” by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12<sup>,</sup> 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).

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Section: Introductionmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

et al. 2023

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“…Setup of the original study and methods of data collection and extraction were described previously and are provided in the online supplemental material 7–9. A textile electrode belt with 32 electrodes was fastened at nipple level 10.…”

Section: Methodsmentioning

confidence: 99%

Lung volume changes during apnoeas in preterm infants

Gaertner

Waldmann

Davis

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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ObjectiveMechanisms of non-invasive high-frequency oscillatory ventilation (nHFOV) in preterm infants are unclear. We aimed to compare lung volume changes during apnoeas in preterm infants on nHFOV and nasal continuous positive airway pressure (nCPAP).MethodsAnalysis of electrical impedance tomography (EIT) data from a randomised crossover trial comparing nHFOV with nCPAP in preterm infants at 26–34 weeks postmenstrual age. EIT data were screened by two reviewers to identify apnoeas ≥10 s. End-expiratory lung impedance (EELI) and tidal volumes (VT) were calculated before and after apnoeas. Oxygen saturation (SpO2) and heart rate (HR) were extracted for 60 s after apnoeas.ResultsIn 30 preterm infants, 213 apnoeas were identified. During apnoeas, oscillatory volumes were detectable during nHFOV. EELI decreased significantly during apnoeas (∆EELI nCPAP: −8.0 (−11.9 to −4.1) AU/kg, p<0.001; ∆EELI nHFOV: −3.4 (−6.5 to −0.3), p=0.03) but recovered over the first five breaths after apnoeas. Compared with before apnoeas, VT was increased for the first breath after apnoeas during nCPAP (∆VT: 7.5 (3.1 to 11.2) AU/kg, p=0.001). Falls in SpO2 and HR after apnoeas were greater during nCPAP than nHFOV (mean difference (95% CI): SpO2: 3.6% (2.7 to 4.6), p<0.001; HR: 15.9 bpm (13.4 to 18.5), p<0.001).ConclusionApnoeas were characterised by a significant decrease in EELI which was regained over the first breaths after apnoeas, partly mediated by a larger VT. Apnoeas were followed by a considerable drop in SpO2 and HR, particularly during nCPAP, leading to longer episodes of hypoxemia during nCPAP. Transmitted oscillations during nHFOV may explain these benefits.Trial registration numberACTRN12616001516471.

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“…Spontaneous breaths and hiccups were visually identified in the EIT raw signal and ventilation characteristics were extracted separately using Matlab (Mathworks, Nantick, MA, USA). We assessed and compared tidal volumes (V T-spont and V T-Hiccup , i.e., difference in lung impedance between start and end of inspiration and hiccup, respectively), inspiratory time (Ti Spont and Ti Hiccup ), regional distribution of tidal volumes in 36 horizontal slices, and the center of ventilation in the vertical (CoV V-D ) as well as the horizontal axis (CoV R-L ) [3, 4]. The CoV describes breath distribution, with higher percentages indicating a shift toward the dorsal and left lung, respectively [4].…”

Section: Case Reportmentioning

confidence: 99%

“…We assessed and compared tidal volumes (V T-spont and V T-Hiccup , i.e., difference in lung impedance between start and end of inspiration and hiccup, respectively), inspiratory time (Ti Spont and Ti Hiccup ), regional distribution of tidal volumes in 36 horizontal slices, and the center of ventilation in the vertical (CoV V-D ) as well as the horizontal axis (CoV R-L ) [3, 4]. The CoV describes breath distribution, with higher percentages indicating a shift toward the dorsal and left lung, respectively [4]. Median values with interquartile ranges (IQR) are presented and comparisons were performed using a Wilcoxon test.…”

Section: Case Reportmentioning

confidence: 99%

Intrapulmonary Volume Changes during Hiccups versus Spontaneous Breaths in a Preterm Infant

et al. 2022

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Hiccups occur at all ages but are most common during fetal development, and accordingly, they are seen regularly in preterm infants. However, the physiologic correlate of hiccups has never been established. We present the case of a preterm infant who developed a spell of hiccups and compared lung volume changes during hiccups with spontaneous breaths using electrical impedance tomography. Hiccups mostly occurred during the expiratory phase of breathing and were associated with a shorter inspiratory time and a larger tidal volume compared with spontaneous breaths. The center of ventilation was shifted toward the ventral (non-gravity-dependent) part of the lung during hiccups and volume changes were mainly restricted to the larger airways, but some gas flow also reached the lung parenchyma. Our observations shed new light on this phenomenon, which is well known but little researched, and our findings may imply a physiological impact of hiccups during fetal development.

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Lung volume distribution in preterm infants on non-invasive high-frequency ventilation

Cited by 8 publications

References 40 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update

Lung volume changes during apnoeas in preterm infants

Intrapulmonary Volume Changes during Hiccups versus Spontaneous Breaths in a Preterm Infant

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