Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis

Fischer, Hendrik; Schmölzer, Georg M.; Cheung, Po–Yin; Bührer, Christoph

doi:10.1183/16000617.0083-2018

Cited by 23 publications

(17 citation statements)

References 44 publications

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“…This indeed may affect the levels of measured pressure. A more prolonger duration of SPI, up to 15 seconds or more had been reported, 3,8 but it was not included in this primitive study because worry its adverse effects of high created PIP. In clinical practice, the real effort of SPI may individualize but that is controlled by the operators.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, this kind of sustained inflation (SI) is accomplished with a gas flow that delivers via different devices of Ambu-facemask, bi-nasal prongs, laryngeal mask airway (LMA), or endotracheal tube (ETT). [1][2][3][4][5][6][7][8] This SI has gradually become a widespread clinical practice. Theoretically, in a relative close space like the PLS, the levels of created PIP may positively correlate to the durations of SPI.…”

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confidence: 99%

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Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

Soong

Chen²,

Lin

et al. 2020

Preprint

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Sustained pharyngeal inflation (SPI) with pharyngeal oxygen and nose-close (PhO2-NC) can create positive inflation pressure (PIP) inside the pharyngolaryngeal space (PLS). This study measured and compared effects of different SPI durations in the PLS. Method: A one-year prospective study, 20 consequent infants whose age less than 3-year-old and scheduled for elective FB were enrolled. SPI performed in four different durations (0.0, 1.0, 3.0 and 5.0 seconds) consequently. Each infant did two cycles of SPI. Measured the PIP of each SPI in the pharynx, and simultaneously took images at three locations of oropharynx, supra-larynx and larynx. Data of infant's demographics, PIP levels, space expansion scores and images were collected and analyzed. Results: Total 20 studied infants, the mean (SD) age was 11.6 (9.1) month-old, the mean (SD) body weight was 6. 8 (2.4) kg and the mean (SD) study time was 3.8 (1.1) minutes. The measured mean (SD) pharyngeal PIPs were 4.1 (3.3), 21.9 (7.0), 42.2 (12.3) and 65.5 (18.5) cmH2O at SPI duration of 0.0, 1.0, 3.0 and 5.0 seconds, respectively. Which showed positively and significantly (p<0.001) correlations. At these assigned locations, the corresponding PLS images also show significant lumen expansion correlated with the PIP. Especially, when there existed pathologic or occult lesions. No any study related complication was noted. Conclusions: SPI with PhO2-NC up to 5 seconds is a simple, safe and feasible clinical ventilation modality. Which could provide enough PIP to expand the PLS and benefit FB performance in infants. Title pagesSustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants-flexible bronchoscopy measurement

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

Soong

Chen²,

Lin

et al. 2020

Preprint

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“…Clinical trials evaluating SI in preterm infants have failed to show similar beneficial effects, with one recent large randomized controlled trial (RCT) stopped early due to increased mortality at less than 48 hours in infants who received SI when compared with regular IPPV. 1,2 There is increasing evidence that monitoring of ventilation, subjectively by observing chest rise or indirectly by its effect on increase in heart rate, may be inadequate. The use of respiratory function monitor to objectively monitor ventilation parameters is one of the strategies with early results showing reduction in mask leaks and lower rates of excessive tidal volume.…”

Section: Respiratory Support At Birthmentioning

confidence: 99%

New Developments in Respiratory Support for Preterm Infants

Jain

Bancalari

2019

Amer J Perinatol

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The evolution of neonatal respiratory support has been one of the cornerstones for the advancements in neonatal–perinatal medicine, allowing survival of infants previously considered not viable. There is an increasing focus on developing strategies which are not only lifesaving but also minimize lung and other organ systems injury, thereby reducing long-term morbidities. Respiratory support immediately after birth is an area that had lagged behind in terms of evidence base and technological advancements until recently. Some of these advancements include use of a respiratory function monitors for measuring flow and tidal volume, new evidence for oxygen supplementation and monitoring, and the efforts to formulate an ideal strategy for establishing functional residual capacity after birth. Increasing evidence for the benefits of avoiding invasive ventilation on reduction of bronchopulmonary dysplasia has resulted in efforts to further reduce the need for endotracheal intubation by applying newer strategies such as less invasive surfactant instillation, noninvasive high-frequency oscillatory ventilation, or use of high flow nasal cannula oxygen. For infants requiring mechanical ventilation, newer strategies such as volume targeted ventilation or neurally adjusted ventilation are being evaluated to reduce ventilator induced lung injury. Despite these advances, there are significant challenges, including lack of conclusive evidence base for many of currently used respiratory strategies, no reduction in the incidence of bronchopulmonary dysplasia in the last decade, and difficulties in defining outcome measures that better reflect long-term respiratory health.

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“…Lung recruitment (LR) at birth using SI of 15-20 s was assessed in numerous randomized controlled trials (RCTs) summarized in 2 recent meta-analyses [10,11]. Despite encouraging results such as a reduced need for intubation, no benefit was found for reduction of mortality or bronchopulmonary dysplasia (BPD).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study

Kanaan

Bloch-Queyrat²,

Boubaya³

et al. 2020

BMC Pediatr

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Background: Lung recruitment at birth has been advocated as an effective method of improving the respiratory transition at birth. Sustained inflations (SI) and dynamic positive end-expiratory pressure (PEEP) were assessed in clinical and animal studies to define the optimal level. Our working hypothesis was that very low gestational age infants (VLGAI) < 32 weeks' gestation require an individualized lung recruitment based on combining both manoeuvers. Methods: Between 2014 and 2016, 91 and 72 inborn VLGAI, requiring a respiratory support beyond a continuous positive airway pressure (CPAP) = 5 cmH2O, were enrolled before and after introducing these manoeuvers based on progressive increase in SI up to 15 s, with simultaneous gradual increase in PEEP up to 15 cmH2O, according to the cardiorespiratory response. Retrospective comparisons of the incidence of mechanical ventilation (MV) < 72 h of life, short-term and before discharge morbidity were then performed.Results: Among extremely low gestational age infants (ELGAI) < 29 weeks' gestation, the following outcomes decreased significantly: intubation (90 to 55%) and surfactant administration (54 to 12%) in the delivery room, MV (92 to 71%) and its mean duration < 72 h of life (45 h to 13 h), administration of a 2nd dose of surfactant (35 to 12%) and postnatal corticosteroids (52 to 19%), and the rate of bronchopulmonary dysplasia (23 to 5%). Among VLGAI, all of these results were also significant. Neonatal mortality and morbidity were not different. Conclusions:In our setting, combining two individualized lung recruitment maneuvers at birth was feasible and may be beneficial on short-term and before discharge pulmonary outcomes. A randomized controlled trial is needed to confirm these results.

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Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis

Cited by 23 publications

References 44 publications

Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

New Developments in Respiratory Support for Preterm Infants

Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study

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