1. Optimisation of neonatal ventilation and resuscitation
- Author
-
Hunt, Katie and Greenough, Anne
- Abstract
Background: Survival of infants requiring neonatal intensive care is improving, but infants may suffer complications related to stabilisation in the delivery suite and ongoing mechanical ventilation. Aim: To undertake a series of studies to optimise ventilatory support both when infants require stabilisation at delivery and also those invasively ventilated on the neonatal unit, with a particular focus on those with evolving or established bronchopulmonary dysplasia (BPD), and congenital diaphragmatic hernia (CDH). Methods: A series of studies were undertaken. 1.A randomised crossover study of the work of breathing (WOB), measured by the pressure-time product of the diaphragm (PTPdi), at different levels of volume targeting in prematurely-born infants with evolving or established BPD. 2. A randomised crossover study of the WOB, measured by the PTPdi, at different levels of volume targeting in infants with CDH. 3. A randomised crossover study of neurally adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV) in prematurely-born infants with evolving or established BPD. 4. A randomised controlled trial of a fifteen second sustained inflation versus standard five 'inflation breaths' lasting two to three seconds during resuscitation at delivery of prematurely-born infants. 5. A study investigating whether the diaphragm EMG measured before extubation predicts those infants who would extubate successfully. 6. A retrospective analysis of the time taken for carbon dioxide to be detected following intubation at delivery in prematurely-born infants. Results: Higher levels of volume targeting (7ml/kg) reduced the work of breathing compared to baseline ventilation and lower levels of volume targeting in infants with evolving/established BPD. In infants with CDH, 5ml/kg reduced the WOB compared to 4ml/kg. There was no significant difference in the oxygenation index between infants ventilated on NAVA and on PAV. A fifteen second sustained inflation during stabilisation at delivery provoked a spontaneous respiratory effort sooner and infants had a reduced duration of ventilation in the first 48 hours. The diaphragm EMG was a poor predictor of successful extubation. There was wide variation in the time taken for carbon dioxide to be detected following intubation.
- Published
- 2021