Theoretical open-loop model of respiratory mechanics in the extremely preterm infant

Fix, Laura Ellwein; Khoury, Joseph; Moores, Russell R.; Linkous, Lauren; Brandes, Matthew E; Rozycki, Henry J.

doi:10.1371/journal.pone.0198425

Cited by 17 publications

(21 citation statements)

References 60 publications

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“…This could have resulted in intermittent de-recruitment of lung volume, and, hence, to increased WOB. 34 35 Intermittent withdrawal of positive airway pressure during interval training may be detrimental for the development of immature lungs.…”

Section: Discussionmentioning

confidence: 99%

Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Delft

Ginderdeuren²,

Lefevere³

et al. 2020

bmjpo

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BackgroundThe optimal method to wean preterm infants from non-invasive respiratory support (NIVRS) with nasal continuous positive airway pressure (CPAP) or high-flow nasal cannula is still unclear, and methods used vary considerably between neonatal units.ObjectivePerform a systematic review and meta-analysis to determine the most effective strategy for weaning preterm infants born before 37 weeks’ gestation from NIVRS.MethodEMBASE, MEDLINE, CINAHL, Google and Cochrane Central Register of Controlled Trials were searched for randomised controlled trials comparing different weaning strategies of NIVRS in infants born before 37 weeks’ gestation.ResultsFifteen trials (1.547 infants) were included. With gradual pressure wean, the relative risk of successful weaning at the first attempt was 1.30 (95% CI 0.93 to 1.83), as compared with sudden discontinuation. Infants were weaned at a later postmenstrual age (PMA) (median difference (MD) 0.93 weeks (95% CI 0.19 to 1.67)). A stepdown strategy to nasal cannula resulted in an almost 3-week reduction in the PMA at successful weaning (MD −2.70 (95% CI −3.87 to −1.52)) but was associated with a significantly longer duration of oxygen supplementation (MD 7.80 days (95% CI 5.31 to 10.28)). A strategy using interval training had no clinical benefits. None of the strategies had any effect on the risk of chronic lung disease or the duration of hospital stay.ConclusionA strategy of gradual weaning of airway pressure might increase the chances of successful weaning. Stepdown strategy from CPAP to nasal cannula is a useful alternative resulting in an earlier weaning, but the focus should remain on continued weaning in order to avoid prolonged oxygen supplementation. Interval training should probably not be used.

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Section: Discussionmentioning

confidence: 99%

Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Delft

Ginderdeuren²,

Lefevere³

et al. 2020

bmjpo

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“…Due to the immaturity of the lung system, very preterm and extremely preterm infants frequently need ventilatory support. NIV has been increasingly used as a ventilatory strategy because it prevents chronic lung diseases, thanks to the reduced traumatic impact on lung structures and the less invasive oxidative stress [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Nonetheless, NIV management and weaning often fail due to the immaturity of the preterm infants’ chest wall pulmonary system [ 37 , 38 ]: the unbalance between pulmonary and chest wall compliance leads to inefficient pulmonary insufflation during diaphragmatic contraction [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Model-Base Estimation of Non-Invasive Ventilation Weaning of Preterm Infants Exposed to Osteopathic Manipulative Treatment: A Propensity-Score-Matched Cohort Study

Tarantino¹,

Vismara

Buffone

et al. 2022

Healthcare

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Ventilation weaning is a key intensive care event influencing preterm infants’ discharge from a neonatal intensive care unit (NICU). Osteopathic manipulative treatment (OMT) has been recently introduced in some Italian NICUs. This retrospective cohort study tested if OMT is associated with faster non-invasive ventilation (NIV) weaning. The time to NIV weaning was assessed in very preterm and very low birth weight infants who either received or did not receive OMT. The propensity score model included gender, antenatal steroids, gestational age (GA), birth weight (BW), and Apgar score 5′. Out of 93 infants, 40 were included in the multilevel survival analysis, showing a reduction of time to NIV weaning for GA (HR: 2.58, 95%CI: 3.91 to 1.71, p < 0.001) and OMT (HR: 3.62, 95%CI: 8.13 to 1.61, p = 0.002). Time to independent ventilation (TIV) was modeled with GA and BW as dependent variables and OMT as the factor. A negative linear effect of GA and BW on TIV was shown. OMT exposure studied as the factor of GA had effects on TIV in infants born up to the 32nd gestational week. Preterm infants exposed to OMT were associated with earlier achievement of NIV weaning. This result, together with the demonstrated OMT safety, suggests the conduct of clinical trials in preterm infants younger than 32 weeks of GA.

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“…RESPIRATORY SYSTEM MECHANICS MODEL. The respiratory system mechanics model is based on a previous model proposed by our team (47), which was further extended in Fix et al (25). It includes the upper airways, the collapsible mid-airways, the small airways, the alveolar compartment, the pleural cavity, and the chest wall.…”

Section: Mathematical Modeling Approachmentioning

confidence: 99%

Influence of nasal CPAP on cardiorespiratory control in healthy neonate

Al-Omar

Rolle

Pladys

et al. 2019

Journal of Applied Physiology

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The present study aimed to further unravel the effects of nasal continuous positive airway pressure (nCPAP) on the cardiovascular and respiratory systems in the neonatal period. Six-hour polysomnographic recordings were first performed in seven healthy newborn lambs, aged 2–3 days, without and with nCPAP application at 6 cmH2O (nCPAP-6), in randomized order. The effects of nCPAP-6 on heart rate variability, respiratory rate variability, and cardiorespiratory interrelations were analyzed using a semiautomatic signal processing approach applied to ECG and respiration recordings. Thereafter, a cardiorespiratory mathematical model was adapted to the experimental conditions to gain further physiological interpretation and to simulate higher nCPAP levels (8 and 10 cmH2O). Results from the signal processing approach suggest that nCPAP-6 applied in newborns with healthy lungs: 1) increases heart rate and decreases the time and frequency domain indices of heart rate variability, especially those representing parasympathetic activity, while increasing the complexity of the RR-interval time series; 2) prolongs the respiratory cycle and expiration duration and decreases respiratory rate variability; and 3) slightly impairs cardiorespiratory interrelations. Model-based analysis revealed that nCPAP-6 increases the heart rate and decreases respiratory sinus arrhythmia amplitude, in association with a reduced parasympathetic efferent activity. These results were accentuated when simulating an increased CPAP level. Overall, our results provide a further understanding of the effects of nCPAP in neonates, in the absence of lung disease. NEW & NOTEWORTHY Application of nasal continuous positive airway pressure (CPAP) at 6 cmH2O, a level very frequently used in newborns, alters heart and respiratory rate variability, as well as cardiorespiratory interrelations in a full-term newborn model without lung disease. Moreover, whereas nasal CPAP at 6 cmH2O decreases parasympathetic efferent activity, there is no change in sympathetic efferent activity.

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Theoretical open-loop model of respiratory mechanics in the extremely preterm infant

Cited by 17 publications

References 60 publications

Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Weaning strategies for the withdrawal of non-invasive respiratory support applying continuous positive airway pressure in preterm infants: a systematic review and meta-analysis

Model-Base Estimation of Non-Invasive Ventilation Weaning of Preterm Infants Exposed to Osteopathic Manipulative Treatment: A Propensity-Score-Matched Cohort Study

Influence of nasal CPAP on cardiorespiratory control in healthy neonate

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