Chiara Veneroni1, Linda Wallström2, Richard Sindelar2, Raffaele L Dellacaʼ3. 1. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy. chiara.veneroni@polimi.it. 2. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. 3. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy.
Abstract
BACKGROUND: We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency. METHODS: Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated. RESULTS: Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1-155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development. CONCLUSIONS: FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.
BACKGROUND: We aimed to evaluate if lung mechanics measured by forced oscillatory technique (FOT) during the first day of life help identify extremely low gestational age newborns (ELGANs) at risk of prolonged mechanical ventilation (MV) and oxygen dependency. METHODS: Positive end-expiratory pressure (PEEP) was increased 2 cmH2O above the clinically set PEEP, then decreased by four 5-min steps of 1 cmH2O, and restored at the clinical value. At each PEEP, FOT measurements were performed bedside during MV. Changes in respiratory mechanics with PEEP, clinical parameters, and chest radiographs were evaluated. RESULTS: Twenty-two newborns (24+4 ± 1+4 wks gestational age (GA); birth weight 653 ± 166 g) on assist/control ventilation were studied. Infants were ventilated for 40 ± 36 d (range 1-155 d), 11 developed severe bronchopulmonary dysplasia (BPD) and one died before 28 d. Early lung mechanics correlated with days on MV, days of respiratory support, and BPD grade. Effects of increasing PEEP on oscillatory reactance assessed by FOT together with GA and radiographic score predicted days on MV (multilinear model, r2 = 0.73). A logistic model considering the same FOT parameter together with GA predicts BPD development. CONCLUSIONS: FOT can be applied bedside in ELGANs, where early changes in lung mechanics with PEEP improve clinical prediction of respiratory outcomes.
Authors: Richard Sindelar; Edward G Shepherd; Johan Ågren; Howard B Panitch; Steven H Abman; Leif D Nelin Journal: Pediatr Res Date: 2021-05-19 Impact factor: 3.756
Authors: Anna Lavizzari; Chiara Veneroni; Francesco Beretta; Valeria Ottaviani; Claudia Fumagalli; Marta Tossici; Mariarosa Colnaghi; Fabio Mosca; Raffaele L Dellacà Journal: Respir Res Date: 2021-12-20