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Войти в исследования Archives of disease in childhood. Fetal and neonatal edition · 2025
Dynamic lung aeration after birth does not impede pulmonary blood flow in preterm lambs.
СтатьяНазвание и аннотация: Перевод в очереди
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Sett Arun, Truong Jennifer, Crotty Anna, Douglas Ellen, Hodder Joel, Poh Qi Hui, Kenna Kelly R, Sourial Magdy, Fatmous Monique, Pereira-Fantini Prue M, Tingay David Gerald
Аннотация
RATIONALE: Stepwise positive end-expiratory pressure at birth (dynamic PEEP) reduces lung injury in preterm lambs; however, the impact of dynamic PEEP on pulmonary blood flow (PBF) during immediate (ICC) and deferred cord clamping (DCC) is unknown.
OBJECTIVES: To determine the impact of dynamic PEEP on PBF during DCC and ICC.
METHODS: Preterm lambs (n=22) received a ventilation strategy with either dynamic PEEP (between 8 and 14 cmH2O) or static PEEP (8 cmH2O) after birth. Lambs were managed with either DCC or ICC (30 s clamp to ventilation) (n=5-6 per group). Left pulmonary artery flow was measured using echocardiography as a surrogate for PBF. Ventilation parameters and PBF were measured every 20 s until 180 s and at 5, 10 and 15 min from ventilation onset.
RESULTS: There was no significant difference in PBF between dynamic and static PEEP applied during DCC (mean (SD) 183 (66) vs 125 (43) mL/kg/min, mean (SD) difference=-58 (103) mL/kg/min, p=0.09) or ICC (124 (26) vs 120 (31) mL/kg/min, mean difference=-4(184), p=0.94). PBF significantly increased over time (p<0.01; mixed effects) in all groups regardless of cord management. This was associated with an increase in the velocity time integral (p<0.01) but no difference in heart rate. Cerebral blood flow reduced over time during DCC (p<0.01) with no change observed during ICC. There was no difference in lung mechanics apart from higher respiratory system compliance in the ICC Dynamic PEEP group (mean difference 0.08 (0.05) mL/kg/cmH2O, p<0.01).
CONCLUSIONS: Elective lung recruitment after birth using a dynamic PEEP does not impede PBF in preterm lambs.
OBJECTIVES: To determine the impact of dynamic PEEP on PBF during DCC and ICC.
METHODS: Preterm lambs (n=22) received a ventilation strategy with either dynamic PEEP (between 8 and 14 cmH2O) or static PEEP (8 cmH2O) after birth. Lambs were managed with either DCC or ICC (30 s clamp to ventilation) (n=5-6 per group). Left pulmonary artery flow was measured using echocardiography as a surrogate for PBF. Ventilation parameters and PBF were measured every 20 s until 180 s and at 5, 10 and 15 min from ventilation onset.
RESULTS: There was no significant difference in PBF between dynamic and static PEEP applied during DCC (mean (SD) 183 (66) vs 125 (43) mL/kg/min, mean (SD) difference=-58 (103) mL/kg/min, p=0.09) or ICC (124 (26) vs 120 (31) mL/kg/min, mean difference=-4(184), p=0.94). PBF significantly increased over time (p<0.01; mixed effects) in all groups regardless of cord management. This was associated with an increase in the velocity time integral (p<0.01) but no difference in heart rate. Cerebral blood flow reduced over time during DCC (p<0.01) with no change observed during ICC. There was no difference in lung mechanics apart from higher respiratory system compliance in the ICC Dynamic PEEP group (mean difference 0.08 (0.05) mL/kg/cmH2O, p<0.01).
CONCLUSIONS: Elective lung recruitment after birth using a dynamic PEEP does not impede PBF in preterm lambs.