Use of Ventilation/perfusion Mismatch to Guide Individualised CPAP Level Selection in Preterm Infants: a Feasibility Trial

Overview

Journal Arch Dis Child Fetal Neonatal Ed

Specialties Gynecology & Obstetrics
Pediatrics

Date 2022 Sep 14

PMID 36104165

Authors

Nicolas A Bamat

Carolyn M Orians

Soraya Abbasi

Colin J Morley

Rob Ross Russell

Howard B Panitch

Sara C Handley

Elizabeth E Foglia

Michael A Posencheg

Haresh Kirpalani

Affiliations

Soon will be listed here.

Abstract

Objective: To measure within-subject changes in ventilation/perfusion (V'/Q') mismatch in response to a protocol of individualised nasal continuous positive airway pressure (CPAP) level selection.

Design: Single-arm, non-randomised, feasibility trial.

Setting: Three centres in the Children's Hospital of Philadelphia neonatal care network.

Patients: Twelve preterm infants of postmenstrual age 27-35 weeks, postnatal age >24 hours, and receiving a fraction of inspired oxygen (FiO) >0.25 on CPAP of 4-7 cm HO.

Interventions: We applied a protocol of stepwise CPAP level changes, with the overall direction and magnitude guided by individual responses in V'/Q' mismatch, as determined by the degree of right shift (kilopascals, kPa) in a non-invasive gas exchange model. Best CPAP level was defined as the final pressure level at which V'/Q' improved by more than 5%.

Main Outcome Measures: Within-subject change in V'/Q' mismatch between baseline and best CPAP levels.

Results: There was a median (IQR) within-subject reduction in V'/Q' mismatch of 1.2 (0-3.2) kPa between baseline and best CPAP levels, p=0.02. Best CPAP was observed at a median (range) absolute level of 7 (5-8) cm HO.

Conclusions: Non-invasive measures of V'/Q' mismatch may be a useful approach for identifying individualised CPAP levels in preterm infants. The results of our feasibility study should be interpreted cautiously and replication in larger studies evaluating the impact of this approach on clinical outcomes is needed.

Trial Registration Number: NCT02983825.

Citing Articles

Unstable SpO in preterm infants: The key role of reduced ventilation to perfusion ratio.

Stoecklin B, Choi Y, Dassios T, Gareth Jones J, Lockwood G, Pillow J Front Physiol. 2023; 14:1112115.

PMID: 36824465 PMC: 9941664. DOI: 10.3389/fphys.2023.1112115.

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