Page 57 - Physiological based CPAP for preterm infants at birth Tessa Martherus

Comparison of two respiratory support strategies for stabilization of very preterm infants at birth
During phase I, the mean airway pressure (low- vs. high- pressure group 12 (6-15) vs. 19 (16-23) cmH2O, p <0.001, Figure 2) and FiO2 (0.30 (0.28-0.31) vs. 0.22 (0.21-0.30), p <0.001) were different between groups (Figure 3). SpO2 (48 (38-59) vs. 49 (38-57)%, p =0.759, Figure 4), heart rate (79 (66-130) vs. 96 (62-120) bpm, p=0.576, Figure 5), and SpO2/FiO2 ratio (1.3 (0.8-2.0) vs. 1.8 (1.2-2.3), p=0.348, Figure 6) were similar between groups. During phase II, the difference in mean airway pressure (8 (6-15) vs. 28 (24-31) cmH2O, p <0.001) and FiO2 (0.62 (0.35-0.98) vs. 0.28 (0.22-0.38), p=0.005) became more pronounced between groups. In the low-pressure group, caffeine was administrated to six infants at 4:45 (4:19-6:36) min. SpO2 (77 (50-92) vs. 53 (42-69)%, p <0.001) was significantly higher in the low-pressure group, whereas heart rate (141 (114-151) vs. 122 (95-140) bpm, p=0.293) and SpO2/FiO2 ratio were not different between groups (1.0 (0.6-2.1) vs. 1.8 (1.1-2.4), p =0.483, Figure 6).
The mean airway pressure of the low-pressure group exceeded the CPAP limit of 8 cmH2O 2 due to contributions of sustained inflations and PPV (Figure 2). 20/27 (74%) infants received sustained inflations. Pressures for the first and second sustained inflations were 20 (20-22)
and 24 (23-25) cmH2O, respectively. According to protocol, 16 infants received two sustained inflations. Three infants received only one sustained inflation, and one infant received three sustained inflations. 22/27 (82%) infants received PPV for 2:08 (1:19-3:01) min using positive inspiratory pressures of 26 (25-27) cmH2O.
Figure 2. Mean airway pressure. Data is presented as median (IQR). Mean airway pressure is the average airway pressure between two inspiratory onsets. In the low-pressure group this includes CPAP, sustained inflations and positive pressure ventilation. In the high-pressure group CPAP was exclusively used.
P
53
r