High-CPAP Does Not Impede Cardiovascular Changes at Birth in Preterm Sheep

Martherus, Tessa; Crossley, Kelly J.; Rodgers, Karyn; Dekker, Janneke; Demel, Anja; Moxham, Alison; Zahra, Valerie; Polglase, Graeme R.; Roberts, Calum T.; Pas, Arjan B Te; Hooper, Stuart B.

doi:10.3389/fped.2020.584138

Cited by 9 publications

(15 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Stimulation of these receptors is thought to initiate a vagal reflex facilitating global pulmonary vasodilation and a subsequent increase in pulmonary blood flow and heart rate ( 32 , 33 ). The outcomes of this study resemble preclinical studies demonstrating that 15 cmH 2 O CPAP improves lung aeration ( 25 ), PBF and heart rate ( 26 ) compared to the currently used CPAP levels. Improved lung aeration would explain why infants required a shortened duration of mask ventilation.…”

Section: Discussionsupporting

confidence: 65%

“…Aeration must positively affect SpO 2 but the relative contribution of aeration vs. the gradient for oxygen diffusion is complex and influenced by other factors such as pulmonary blood flow and cardiac output. Previous studies in preterm sheep showed that 8 and 15 cmH 2 O CPAP improved oxygenation and lowered FiO 2 requirements as compared to 5 cmH 2 O CPAP ( 26 , 31 ). We found no effect on oxygenation in this study, however the effect of PB-CPAP on SpO 2 could have been diminished by the large difference in gestational age, high FiO 2 levels in both groups and the fact that the power requirements with respect to sample size could not be met.…”

Section: Discussionmentioning

confidence: 88%

“…PB-CPAP has so far only been investigated in a preclinical setting. Preterm rabbit ( 25 ) and sheep ( 26 ) studies demonstrated that initially, 15 cmH 2 O CPAP improves lung aeration, facilitates cardiovascular stability and better supports spontaneous breathing compared to the currently used CPAP levels. Lung aeration and breathing rates could be maintained if CPAP was gradually decreased to at least 8 cmH 2 O but did increase oxygen requirements.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background: Preterm infants are commonly supported with 5–8 cmH2O CPAP. However, animal studies demonstrate that high initial CPAP levels (12–15 cmH2O) which are then reduced (termed physiological based (PB)-CPAP), improve lung aeration without adversely affecting cardiovascular function. We investigated the feasibility of PB-CPAP and the effect in preterm infants at birth.Methods: Preterm infants (24–30 weeks gestation) were randomized to PB-CPAP or 5–8 cmH2O CPAP for the first 10 min after birth. PB-CPAP consisted of 15 cmH2O CPAP that was decreased when infants were stabilized (heart rate ≥100 bpm, SpO2 ≥85%, FiO2 ≤ 0.4, spontaneous breathing) to 8 cmH2O with steps of ~2/3 cmH2O/min. Primary outcomes were feasibility and SpO2 in the first 5 min after birth. Secondary outcomes included physiological and breathing parameters and short-term neonatal outcomes. Planned enrollment was 42 infants.Results: The trial was stopped after enrolling 31 infants due to a low inclusion rate and recent changes in the local resuscitation guideline that conflict with the study protocol. Measurements were available for analysis in 28 infants (PB-CPAP n = 8, 5–8 cmH2O n = 20). Protocol deviations in the PB-CPAP group included one infant receiving 3 inflations with 15 cmH2O PEEP and two infants in which CPAP levels were decreased faster than described in the study protocol. In the 5–8 cmH2O CPAP group, three infants received 4, 10, and 12 cmH2O CPAP. During evaluations, caregivers indicated that the current PB-CPAP protocol was difficult to execute. The SpO2 in the first 5 min after birth was not different [61 (49–70) vs. 64 (47–74), p = 0.973]. However, infants receiving PB-CPAP achieved higher heart rates [121 (111–130) vs. 97 (82–119) bpm, p = 0.016] and duration of mask ventilation was shorter [0:42 (0:34–2:22) vs. 2:58 (1:36–6:03) min, p = 0.020]. Infants in the PB-CPAP group required 6:36 (5:49-11:03) min to stabilize, compared to 9:57 (6:58–15:06) min in the 5–8 cmH2O CPAP group (p = 0.256). There were no differences in short-term outcomes.Conclusion: Stabilization of preterm infants with PB-CPAP is feasible but tailoring CPAP appeared challenging. PB-CPAP did not lead to higher SpO2 but increased heart rate and shortened the duration of mask ventilation, which may reflect faster lung aeration.

show abstract

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The optimal CPAP levels for initiating respiratory support in the DR in spontaneously breathing premature infants born after <25 weeks' gestation should be addressed in future trials. Interestingly, a recent animal study has shown that higher initial CPAP levels (15 cmH 2 O) compared to 5 cmH 2 O resulted in higher pulmonary blood flow levels when applied from birth, without causing pulmonary overexpansion, cardiovascular compromise or increased risk for IVH [76]. Indeed, while higher PEEP levels during mechanical ventilation enhance lung aeration and oxygenation and reduce intubation rates, they reduce pulmonary blood flow and may increase the risk of pneumothorax [77,78].…”

Section: Continuous Positive Airway Pressurementioning

confidence: 99%

“…Nevertheless, physiology might be immediately different after birth when the high resistance lungs need to be cleared from fluids. A new, promising, 'physiological' approach that needs further investigation is a dynamic (high) CPAP level during the first minutes after birth (e.g., 15 decreasing to 8 cmH 2 O at~2 cmH 2 O/min) which takes into account the changes in lung function during stabilization in the DR [76].…”

Section: Continuous Positive Airway Pressurementioning

confidence: 99%

Delivery Room Care for Premature Infants Born after Less than 25 Weeks’ Gestation—A Narrative Review

2021

View full text Add to dashboard Cite

Premature infants born after less than 25 weeks’ gestation are particularly vulnerable at birth and stabilization in the delivery room (DR) is challenging. After birth, infants born after <25 weeks’ gestation develop respiratory and hemodynamic instability due to their immature physiology and anatomy. Successful stabilization at birth has the potential to reduce morbidities and mortalities, while suboptimal DR care could increase long-term sequelae. This article reviews current neonatal resuscitation guidelines and addresses challenges during DR stabilization in extremely premature infants born after <25 weeks’ gestation at the threshold of viability.

show abstract

A physiological approach to applying CPAP in the preterm infant

Polin

Sahni

2023

The Anatomical Record

View full text Add to dashboard Cite

Nasal continuous positive airway pressure (CPAP) is increasingly used for respiratory support in preterm infants with respiratory distress syndrome at birth and after extubation from mechanical ventilation. Controversies with CPAP use still exists due to non‐uniformity of devices and interfaces used, equivalence of testing conditions for different CPAP systems, differences in study designs, and short study periods that may be insufficient to detect important and relevant clinical outcomes. Compared with ventilator‐derived constant‐pressure flow‐opposition CPAP, variable fluidic flow‐opposition CPAP systems may be advantageous and offer some clinical benefits. The distinction between constant‐flow fluid‐sealed bubble CPAP and variable‐flow fluidic flow‐opposition systems is less clear. Appropriately designed randomized clinical trials that separately address the controversies with CPAP use in various clinical settings, are necessary to determine which CPAP system results in best outcomes.

show abstract

High-CPAP Does Not Impede Cardiovascular Changes at Birth in Preterm Sheep

Cited by 9 publications

References 56 publications

Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth

Feasibility and Effect of Physiological-Based CPAP in Preterm Infants at Birth

Delivery Room Care for Premature Infants Born after Less than 25 Weeks’ Gestation—A Narrative Review

A physiological approach to applying CPAP in the preterm infant

Contact Info

Product

Resources

About