Sustained lung inflation at birth: what do we know, and what do we need to know?

McCall, Karen; Davis, Peter G; Owen, Louise; Tingay, David G.

doi:10.1136/archdischild-2015-309611

Cited by 20 publications

(23 citation statements)

References 47 publications

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“…There were better physiological outcomes in the OLV group and no difference between the SI and PPV only groups (6). Finally, although pneumothoraces were not found in our study population, reports in similar preterm lamb studies (6,17), and some human studies of SI (18,19), illustrate that the interaction between applied pressure and air leak in the preterm lung is not well understood. Interesting, in the already-aerated lung, air leak has not been a feature of OLV strategies in human (31,33) and animal studies (32,34,35).…”

Section: Discussioncontrasting

confidence: 43%

“…The pressure and time criteria for the SI and OLV strategies used in our study are not consistent with human studies (18,19). To achieve lung aeration at birth, and then maintain recruitment and tidal ventilation, a recruitment strategy needs to overcome specific the mechanical and time constant constraints of the respiratory system (1,6,23).…”

Section: Discussionmentioning

confidence: 63%

“…In unintubated preterm infants, the glottis is often closed at birth, which may limit the ability to deliver a sufficient volume to the lung (40). Pressure and V T delivery during facemask support is further complicated by operated-related variable delivery (18). Although both the OLV and SI strategy could be practically applied using a facemask and a variable pressure system (such as the Neopuff), we elected to use an intubated model to ensure standardization of the strategy effect.…”

Section: Discussionmentioning

confidence: 99%

“…This supports the argument that PEEP, and how it is used, Articles maybe more important than the first inflation at birth. To date, a number of trials of SI but not PEEP recruitment at birth have been performed in humans (4,18,19). Surfactant is known to improve lung mechanics and oxygenation, and its benefits in preterm infants are well established (2).…”

Section: Discussionmentioning

confidence: 99%

“…However, clinical trials at birth are lacking. The most widely examined intentional recruitment maneuver at birth is the use of an initial sustained inflation (SI) to clear fetal lung liquid from the airways (18,19). Preclinical experimental studies of SI have been mixed (5,6,(9)(10)(11)20), with an increase in lung injury reported in some studies (21-23).…”

mentioning

confidence: 99%

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The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

et al. 2016

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Background:To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (C dyn ) in preterm lambs. Methods: Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH 2 O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO 2 ) and C dyn measured at regular time points. results: Overall, the OLV strategy improved C dyn and AaDO 2 (all epochs except Surfactant) compared to SI (all P < 0.05; twoway ANOVA). Irrespective of strategy, C dyn was better in the Steroid group in the first 10 min (all P < 0.05). Thereafter, C dyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO 2 more than SI (P = 0.235). conclusions: The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEPbased time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.i t is widely agreed that the optimal support of the preterm lung involves the combination of antenatal corticosteroid exposure, exogenous surfactant therapy, and early application of lung protective respiratory support strategies (1). Together, these therapies reduce the potential of assisted ventilation to injure the developmentally immature, surfactant-deficient preterm lung. The roles of early exogenous surfactant therapy (2) and antenatal corticosteroids (3) in improving lung mechanics, functional residual capacity, and reducing respiratory support are well established. The optimal respiratory support strategies are still debated (4-7).Ideally, lung protective respiratory support should commence during transition to ex utero life (1,8). During this period, the infant must rapidly clear lung liquid, aerate the lung, establish a functional residual capacity, and commence tidal ventilation, processes influenced by the intrinsic mechanical properties of the lung as well as the applied respiratory strategy (5,6,9-13). The optimal approach in preterm infants remains unclear but broadly requires an inflating pressure to drive fetal lung fluid into the alveoli and allow lung aeration, and positive end-expiratory pressure (PEEP) to maintain aeration and prevent fluid efflux back into the airways (14-17). In preterm animals, using an initial stepwise PEEP or open lung ventilation (OLV) approach during tidal ventilation from birth improves aeration and short-term respiratory outcomes in preterm animals via utilizing hysteresis and time dependency (6,11). However, clinical trials at birth...

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Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

et al. 2016

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Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes

Bruschettini¹,

O’Donnell²,

Davis³

et al. 2017

Cochrane Database of Systematic Reviews

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Background At birth, infants' lungs are fluid-filled; this fluid must be replaced by air to allow for effective breathing. Some infants are judged to have inadequate breathing at birth and are resuscitated with positive pressure ventilation (PPV). Giving prolonged (sustained) inflations at the start of PPV may help clear lung fluid and establish gas volume in the lungs. Objectives To assess the efficacy of initial sustained (> one second duration) lung inflation compared to standard inflations (≤ one second) in newly born infants receiving resuscitation with intermittent PPV.

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Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes

Bruschettini

O’Donnell

Davis

et al. 2020

Cochrane Database of Systematic Reviews

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Sustained lung inflation at birth: what do we know, and what do we need to know?

Cited by 20 publications

References 47 publications

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes

Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes

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