Regional Volume Characteristics of the Preterm Infant Receiving First Intention Continuous Positive Airway Pressure

To determine whether applying nasal continuous positive airway pressure (CPAP) using systematic changes in continuous distending pressure (CDP) results in a quasi-static pressure–volume relationship in very preterm infants receiving first intention CPAP in the first 12-18 hours of life. Twenty infan...

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Published in:The Journal of pediatrics 2017-08, Vol.187, p.80-88.e2
Main Authors: Bhatia, Risha, Davis, Peter G., Tingay, David G.
Format: Article
Language:English
Subjects:
Continuous Positive Airway Pressure - methods
Electric Impedance
Female
Humans
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Lung - physiopathology
Lung Volume Measurements - methods
Male
Prospective Studies
recruitment
Respiratory Distress Syndrome, Newborn - physiopathology
Respiratory Distress Syndrome, Newborn - therapy
ventilation distribution
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cited_by cdi_FETCH-LOGICAL-c359t-3f5c31eaec4ce7ad0c0d3042dca3bb24980af66bd4153ac52ff8b438edf4cc8e3
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container_title The Journal of pediatrics
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creator Bhatia, Risha
Davis, Peter G.
Tingay, David G.
description To determine whether applying nasal continuous positive airway pressure (CPAP) using systematic changes in continuous distending pressure (CDP) results in a quasi-static pressure–volume relationship in very preterm infants receiving first intention CPAP in the first 12-18 hours of life. Twenty infants at
doi_str_mv 10.1016/j.jpeds.2017.04.046
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Twenty infants at &lt;32 weeks' gestation with mild respiratory distress syndrome (RDS) managed exclusively with nasal CPAP had CDP increased from 5 to 8 to 10 cmH2O, and then decreased to 8 cmH2O and returned to baseline CDP. Each CDP was maintained for 20 min. At each CDP, relative impedance change in end-expiratory thoracic volume (ΔZEEV) and tidal volume (ΔZVT) were measured using electrical impedance tomography. Esophageal pressure (Poes) was measured as a proxy for intrapleural pressure to determine transpulmonary pressure (Ptp). Overall, there was a relationship between Ptp and global ΔZEEV representing the pressure–volume relationship in the lungs. There were regional variations in ΔZEEV, with 13 infants exhibiting hysteresis with the greatest gains in EEV and tidal volume in the dependent lung with no hemodynamic compromise. Seven infants did not demonstrate hysteresis during decremental CDP changes. It was possible to define a pressure–volume relationship of the lung and demonstrate reversal of atelectasis by systematically manipulating CDP in most very preterm infants with mild RDS. 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subjects Continuous Positive Airway Pressure - methods
Electric Impedance
Female
Humans
Infant, Newborn
Infant, Premature
Intensive Care Units, Neonatal
Lung - physiopathology
Lung Volume Measurements - methods
Male
Prospective Studies
recruitment
Respiratory Distress Syndrome, Newborn - physiopathology
Respiratory Distress Syndrome, Newborn - therapy
ventilation distribution
title Regional Volume Characteristics of the Preterm Infant Receiving First Intention Continuous Positive Airway Pressure
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