Page 161 - Physiological based CPAP for preterm infants at birth Tessa Martherus

statistical differences in SpO2 or FiO2. In this study, there were no indications for increased risk of adverse events, however the low number of included infants prevented us from making appropriate conclusions on short-term outcomes.
Conclusion
In the General discussion we discuss the beneficial effect of PB-CPAP on establishing and maintaining lung aeration, as demonstrated in our experimental studies. In addition, no cardiopulmonary adverse effect could be demonstrated in the experimental setting. We demonstrated in our clinical study that infants reached cardiovascular stability sooner, shortening the duration of mask ventilation. While improved aeration positively affects oxygenation in preterm lambs, we found no effect of CPAP on SpO2 and FiO2 in our clinical trial, which apart from a small sample size, can likely be attributed to the use of high FiO2 levels. Our findings of the effect of PB-CPAP on breathing effort were conflicting. As spontaneous breathing depends on various competing factors and can be influenced by oxygenation or tactile stimulation, for example, the true effect of CPAP levels on breathing effort remains unclear.
In this thesis, we also found that the timing of reducing CPAP levels following stabilization is essential. Decreasing CPAP levels too soon leads to an increase the FiO2 requirement, but decreasing CPAP levels too late may increase the risk of adverse events. To ensure the optimal CPAP decrease in our clinical trial, the PB-CPAP approach involved several predefined evaluations and changes in CPAP levels. This has shown to be too complex for caregivers and hard to combine with standard delivery room care. While a more pragmatic approach with a less complicated algorithm would increase feasibility, this should be balanced against the importance of optimal timing of the CPAP level reduction. Future studies are needed to test the feasibility and effectiveness of this improved BP-CPAP approach before it can be implemented in daily practice.
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