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Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs

Citation

Polglase, GR and Tingay, DG and Bhatia, R and Berry, CA and Kopotic, RJ and Kopotic, CP and Song, Y and Szyld, E and Jobe, AH and Pillow, JJ, Pressure- versus volume-limited sustained inflations at resuscitation of premature newborn lambs, BMC Paediatrics, 14 Article 43. ISSN 1471-2431 (2014) [Refereed Article]


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Copyright Statement

2014 Polglase et al.; licensee BioMed Central Ltd. Licensed under Creative Commons Attribution 2.0 Generic (CC BY 2.0) https://creativecommons.org/licenses/by/2.0/

DOI: doi:10.1186/1471-2431-14-43

Abstract

Background: Sustained inflations (SI) are advocated for the rapid establishment of FRC after birth in preterm and term infants requiring resuscitation. However, the most appropriate way to deliver a SI is poorly understood. We investigated whether a volume-limited SI improved the establishment of FRC and ventilation homogeneity and reduced lung inflammation/injury compared to a pressure-limited SI.

Methods: 131 d gestation lambs were resuscitated with either: i) pressure-limited SI (PressSI: 0-40 cmH2O over 5 s, maintained until 20 s); or ii) volume-limited SI (VolSI: 0-15 mL/kg over 5 s, maintained until 20 s). Following the SI, all lambs were ventilated using volume-controlled ventilation (7 mL/kg tidal volume) for 15 min. Lung mechanics, regional ventilation distribution (electrical impedance tomography), cerebral tissue oxygenation index (near infrared spectroscopy), arterial pressures and blood gas values were recorded regularly. Pressure-volume curves were performed in-situ post-mortem and early markers of lung injury were assessed.

Results: Compared to a pressure-limited SI, a volume-limited SI had increased pressure variability but reduced volume variability. Each SI strategy achieved similar end-inflation lung volumes and regional ventilation homogeneity. Volume-limited SI increased heart-rate and arterial pressure faster than pressure-limited SI lambs, but no differences were observed after 30 s. Volume-limited SI had increased arterial-alveolar oxygen difference due to higher FiO2 at 15 min (p = 0.01 and p = 0.02 respectively). No other inter-group differences in arterial or cerebral oxygenation, blood pressures or early markers of lung injury were evident.

Conclusion: With the exception of inferior oxygenation, a sustained inflation targeting delivery to preterm lambs of 15 mL/kg volume by 5 s did not influence physiological variables or early markers of lung inflammation and injury at 15 min compared to a standard pressure-limited sustained inflation.

Item Details

Item Type:Refereed Article
Keywords:mechanical ventilation, infant, newborn, lung recruitment, ventilation homogeneity, variability
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Respiratory Diseases
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Respiratory System and Diseases (incl. Asthma)
UTAS Author:Song, Y (Dr Yong Song)
ID Code:135706
Year Published:2014
Web of Science® Times Cited:23
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-11-08
Last Modified:2019-12-05
Downloads:3 View Download Statistics

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