Prematurely born infants' response to resuscitation via an endotracheal tube or a face mask

Murthy, Vadivelam; D'Costa, Walton; Shah, Rahul; Fox, Grenville; Campbell, Morag; Milner, Anthony; Greenough, Anne

doi:10.1016/j.earlhumdev.2015.02.004

Cited by 18 publications

(28 citation statements)

References 12 publications

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“…The time for ETCO 2 to be detected was negatively correlated with the tidal volume; this is consistent with previous research that has demonstrated that after an infant makes a spontaneous respiratory effort, the tidal volume increases 19. Hence, if there is no change in the inflation pressures, the compliance improves; thus, we saw a negative correlation between the time for the ETCO 2 to be detected and the compliance.…”

Section: Discussionsupporting

confidence: 91%

Detection of exhaled carbon dioxide following intubation during resuscitation at delivery

Hunt

Yamada

Murthy

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionsupporting

confidence: 91%

Detection of exhaled carbon dioxide following intubation during resuscitation at delivery

Hunt

Yamada

Murthy

et al. 2018

Arch Dis Child Fetal Neonatal Ed

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“…It shows that when a baby was apnoeic during an SI, only a small volume of gas entered the lungs. This is consistent with Boon et al [17] and Murthy et al [7] who reported that during ventilation with a mask and T-piece, and an inflation pressure of about 20 cmH 2 O, good lung aeration only occurred if the babies breathed. van Vonderen [11] reported that the gain in residual volume in preterm infants receiving an SI occurred only in breathing infants.…”

Section: Discussionsupporting

confidence: 81%

“…They speculated that a longer inflation time would increase the tidal volume (Vt) and showed that the Vt was double when the initial inflation pressure was maintained for approximately 5 s. According to these findings, the last European Resuscitation Council (ERC) neonatal guidelines recommend to maintain the initial pressure for 2-3 s for the first 5 inflations [6]. Moreover, resuscitation via an endotracheal tube or face mask is more effective when the infant's inspiratory effort coincided with an inflation [7]. …”

Section: Introductionmentioning

confidence: 99%

Effects of Breathing and Apnoea during Sustained Inflations in Resuscitation of Preterm Infants

et al. 2017

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Background: A sustained inflation (SI) at birth in preterm babies may be ineffective unless the infants breathe. Gain in lung volume is associated with breathing during delivery room non-invasive management. Objective: To describe the breathing patterns of preterm infants during an SI and correlate to a calculated gain in lung volume. Methods: Retrospective observational study. Data collected from a respiratory function monitor during SI (25 cmH₂O for 15 s then PEEP at 5 cmH₂O) through a face mask in preterm infants (gestational age [GA] ≤31 weeks). Spontaneous breaths, inspiratory time (TI), inspiratory/expiratory tidal volume (Vti/Vte), and gain in lung volume were determined. Results: 30 SIs in 20 infants (mean GA 27 weeks; birth weight 825 g) were analysed and stratified in 2 groups according to spontaneous breathing: SIs without spontaneous breaths (apnoea: n = 11) and SIs with spontaneous breaths (breathing: n = 19). Mean GA was lower in the apnoea group versus the breathing group (25 vs. 27⁺⁵ weeks; p = 0.01). Mean birth weight was lower in the apnoea group versus the breathing group (683 vs. 860 g; p = ns). In the breathing group, the mean number of spontaneous breaths was 4 with a mean TI of 0.52 min, the mean Vti/kg was 5.9 mL/kg, and the mean Vt_e was 2.7 mL/kg. The calculated mean gain in lung volume was 7.5 mL/kg in the apnoea group and 17.8 mL/kg in the breathing group (p = 0.039). Conclusions: Actively breathing infants during an SI at birth showed a gain in lung volume higher than apnoeic infants. Spontaneous breathing during SI seems to be related to GA.

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“…The SBT has been reported to have a sensitivity of 97% in predicting extubation outcome [16], which is enhanced to 100% by incorporating measurements of respiratory variability [8]. Unfortunately, the specificity of the SBT is only moderate (73%) [3], increasing to only 75% by incorporating information on respiratory variability [18]. In our cohort, the SBT had a sensitivity of 100% in predicting extubation failure, but the specificity of the test was low (22%).…”

Section: Discussionmentioning

confidence: 99%

“…A respiratory function monitor (NM3 respiratory profile monitor; Philips Respironics, Wallingford, CT, USA) [17,18] was used. The monitor was connected to a Laptop (Dell Latitude; Dell, Bracknell, UK) with customised Spectra software (3.0.1.4; Grove Medical, London, UK).…”

Section: Methodsmentioning

confidence: 99%

Relaxation Rate of the Respiratory Muscles and Prediction of Extubation Outcome in Prematurely Born Infants

2017

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Background: Accurate prediction of extubation outcome could result in a significant reduction of respiratory morbidity in premature neonates. Objectives: To assess whether the respiratory muscle time constant of relaxation (τ) predicted extubation outcome in mechanically ventilated, premature infants. Methods: Forty-six mechanically ventilated infants with a median gestational age of 26 (interquartile range [IQR] 25-29) weeks were prospectively studied. τ was calculated from the reciprocal of the slope of the decline in airway pressure as a function of time. Measurements of τ were done during 5-10 min of a spontaneous breathing test (SBT) prior to extubation. During the first and last minute of the SBT, τ₁ and τ₂, respectively, were assessed, and the difference between them was calculated (Δτ). Results: The median τ₂ was significantly higher in infants whose extubation failed (20.7 [IQR 12.9-34.7] s/cm H₂O) than in infants whose extubation succeeded (8.2 [IQR 6.2-17.8] s/cm H₂O, p = 0.002). The median Δτ was significantly higher in infants whose extubation failed (10.3 [IQR 4.4-23.9] s/cm H₂O) than in infants whose extubation succeeded (-1.63 [IQR -5.7 to 0.3] s/cm H₂O, p = 0.001). Extubation failure was associated with τ₂ (p = 0.011) and Δτ (p = 0.010) after correcting for postmenstrual age, patent ductus arteriosus, and intraventricular haemorrhage. Receiver operator characteristic curve analysis demonstrated that Δτ predicted extubation failure with an area under the curve of 0.937. A Δτ of +1.02 s/cm H₂O predicted extubation failure with 94% sensitivity and 83% specificity. Conclusions: The respiratory muscle time constant of relaxation during an SBT was significantly greater in infants whose extubation failed and could be used to predict extubation outcome in prematurely born infants.

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Prematurely born infants' response to resuscitation via an endotracheal tube or a face mask

Cited by 18 publications

References 12 publications

Detection of exhaled carbon dioxide following intubation during resuscitation at delivery

Detection of exhaled carbon dioxide following intubation during resuscitation at delivery

Effects of Breathing and Apnoea during Sustained Inflations in Resuscitation of Preterm Infants

Relaxation Rate of the Respiratory Muscles and Prediction of Extubation Outcome in Prematurely Born Infants

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