Regional ventilation characteristics during non-invasive respiratory support in preterm infants

Thomson, Jessica; Rüegger, Christoph M.; Perkins, Elizabeth; Pereira‐Fantini, Prue M.; Farrell, Olivia; Owen, Louise; Tingay, David G.

doi:10.1136/archdischild-2020-320449

Cited by 12 publications

(18 citation statements)

References 42 publications

(82 reference statements)

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“…Preterm infants predominantly use their diaphragm to generate tidal ventilation, and previous EIT studies in infants have shown that the dorsal lung is preferentially ventilated during spontaneous breathing. 9,13,14 The ventral-dorsal shape of the diaphragm is elliptical. Thus, there is greater movement of the dorsal portion of the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

“…All infants were managed supine to standardise measures however, prone positioning is widely used in NICU, and as we have shown in more recent studies, may improve ventilation patterns. 9,14…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extubation generates lung volume inhomogeneity in preterm infants

Bhatia

Carlisle

Armstrong

et al. 2021

Preprint

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Objective: To evaluate the feasibility of EIT to describe the regional tidal ventilation (VT) and change in end-expiratory lung volume (EELV) patterns in preterm infants during the process of extubation from invasive to non-invasive respiratory support. Design: Prospective observational study Setting: Single-centre tertiary neonatal intensive care unit Patients: Preterm infants born <32 weeks gestation who were being extubated to nasal continuous positive airway pressure (nCPAP) as per clinician discretion. Interventions: Electrical Impedance Tomography measurements were taken in supine infants during elective extubation from synchronised positive pressure ventilation (SIPPV) before extubation, during and then at 2 and 20 minutes after commencing nCPAP. Extubation and pressure settings were determined by clinicians. Main outcome measures: Global and regional ΔEELV and ΔVT were measured. Heart rate, respiratory rate and oxygen saturation were measured throughout. Results: Thirty infants of median (range) 2 (1, 21) days were extubated to a median (range) CPAP 7 (6, 8) cmH2O. SpO2/FiO2 ratio was mean (95% CI) 50 (35, 65) lower 20 minutes after nCPAP compared with SIPPV. EELV was lower at all points after extubation compared to SIPPV, and EELV loss was primarily in the ventral lung (p=0.04). VT was increased immediately after extubation, especially in the central and ventral regions of the lung, but the application of nCPAP returned VT to pre-extubation patterns. Conclusions: Lung behaviour during the transition from invasive positive pressure ventilation to nCPAP at moderate distending pressures is variable and associated with lung volume loss in the ventral lung.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Extubation generates lung volume inhomogeneity in preterm infants

Bhatia

Carlisle

Armstrong

et al. 2021

Preprint

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“…Second, overall changes in ventilation including silent spaces (SS), the deviation from the ideal centre of ventilation (ideal minus actual centre of ventilation; CoV i−a ) and the coefficient of variation (CV) were calculated (see figure 1A). 9 15 SS correspond to areas of the lung with little or no ventilation,16 and were calculated in the gravity-dependent (GD) and NGD hemithorax separately ( SS GD and SS NGD , respectively). The CoV i−a indicates a difference in ventilation in respective lung areas (eg, GD or NGD).…”

Section: Methodsmentioning

confidence: 99%

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

Gaertner

Waldmann

Davis

et al. 2022

Arch Dis Child Fetal Neonatal Ed

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IntroductionNon-invasive high-frequency oscillatory ventilation (nHFOV) is an extension of nasal continuous positive airway pressure (nCPAP) support in neonates. We aimed to compare global and regional distribution of lung volumes during nHFOV versus nCPAP.MethodsIn 30 preterm infants enrolled in a randomised crossover trial comparing nHFOV with nCPAP, electrical impedance tomography data were recorded in prone position. For each mode of respiratory support, four episodes of artefact-free tidal ventilation, each comprising 30 consecutive breaths, were extracted. Tidal volumes (VT) in 36 horizontal slices, indicators of ventilation homogeneity and end-expiratory lung impedance (EELI) for the whole lung and for four horizontal regions of interest (non-gravity-dependent to gravity-dependent; EELINGD, EELImidNGD, EELImidGD, EELIGD) were compared between nHFOV and nCPAP. Aeration homogeneity ratio (AHR) was determined by dividing aeration in non-gravity-dependent parts of the lung through gravity-dependent regions.Main resultsOverall, 228 recordings were analysed. Relative VT was greater in all but the six most gravity-dependent lung slices during nCPAP (all p<0.05). Indicators of ventilation homogeneity were similar between nHFOV and nCPAP (all p>0.05). Aeration was increased during nHFOV (mean difference (95% CI)=0.4 (0.2 to 0.6) arbitrary units per kilogram (AU/kg), p=0.013), mainly due to an increase in non-gravity-dependent regions of the lung (∆EELINGD=6.9 (0.0 to 13.8) AU/kg, p=0.028; ∆EELImidNGD=6.8 (1.2 to 12.4) AU/kg, p=0.009). Aeration was more homogeneous during nHFOV compared with nCPAP (mean difference (95% CI) in AHR=0.01 (0.00 to 0.02), p=0.0014).ConclusionAlthough regional ventilation was similar between nHFOV and nCPAP, end-expiratory lung volume was higher and aeration homogeneity was slightly improved during nHFOV. The aeration difference was greatest in non-gravity dependent regions, possibly due to the oscillatory pressure waveform. The clinical importance of these findings is still unclear.

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“…7,8 These have shown complex regional ventilation and aeration patterns occurring even in preterm infants considered stable, with relatively low fraction of inspired oxygen (FiO 2 ), on nCPAP. 9 This study aimed to evaluate the feasibility of EIT to describe the regional tidal ventilation (V T ) and end-expiratory lung volume (EELV) patterns in preterm infants during the process of successful elective extubation to nCPAP. To address these aims, we analysed our dataset of EIT measurements from preterm infants made as part of a series of studies conducted between 2008-2013.…”

Section: Introductionmentioning

confidence: 99%

Extubation generates lung volume inhomogeneity in preterm infants

Bhatia

Carlisle

Armstrong

et al. 2021

Arch Dis Child Fetal Neonatal Ed

Self Cite

View full text Add to dashboard Cite

ObjectiveTo evaluate the feasibility of electrical impedance tomography (EIT) to describe the regional tidal ventilation (VT) and change in end-expiratory lung volume (EELV) patterns in preterm infants during the process of extubation from invasive to non-invasive respiratory support.DesignProspective observational study.SettingSingle-centre tertiary neonatal intensive care unit.PatientsPreterm infants born <32 weeks’ gestation who were being extubated to nasal continuous positive airway pressure as per clinician discretion.InterventionsEIT measurements were taken in supine infants during elective extubation from synchronised positive pressure ventilation (SIPPV) before extubation, during and then at 2 and 20 min after commencing nasal continuous positive applied pressure (nCPAP). Extubation and pressure settings were determined by clinicians.Main outcome measuresGlobal and regional ΔEELV and ΔVT, heart rate, respiratory rate and oxygen saturation were measured throughout.ResultsThirty infants of median (range) 2 (1, 21) days were extubated to a median (range) CPAP 7 (6, 8) cm H2O. SpO2/FiO2 ratio was a mean (95% CI) 50 (35, 65) lower 20 min after nCPAP compared with SIPPV. EELV was lower at all points after extubation compared with SIPPV, and EELV loss was primarily in the ventral lung (p=0.04). VT was increased immediately after extubation, especially in the central and ventral regions of the lung, but the application of nCPAP returned VT to pre-extubation patterns.ConclusionsEIT was able to describe the complex lung conditions occurring during extubation to nCPAP, specifically lung volume loss and greater use of the dorsal lung. EIT may have a role in guiding peri-extubation respiratory support.

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Regional ventilation characteristics during non-invasive respiratory support in preterm infants

Cited by 12 publications

References 42 publications

Extubation generates lung volume inhomogeneity in preterm infants

Extubation generates lung volume inhomogeneity in preterm infants

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

Extubation generates lung volume inhomogeneity in preterm infants

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