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CPAP of 4 cm H(2)O Has No Short-Term Benefit at Term in Infants with BPD.

Artikel i vetenskaplig tidskrift
Författare Kenneth Sandberg
Ola Hjalmarson
Publicerad i Neonatology
Volym 102
Nummer/häfte 4
Sidor 282-286
ISSN 1661-7819
Publiceringsår 2012
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för pediatrik
Sidor 282-286
Språk en
Länkar dx.doi.org/10.1159/000341765
Ämneskategorier Reproduktiv och perinatal omvårdnad

Sammanfattning

Background: Lung development and function is compromised at term in infants with bronchopulmonary dysplasia (BPD), characterized by reduced functional residual capacity (FRC) and impaired gas-mixing efficiency in distal airways. Objective: To determine whether continuous positive airway pressure (CPAP) improves FRC, ventilation, distal airway function, and gas exchange in spontaneously breathing infants with BPD. Design/Methods: Twenty-one infants with BPD (median birth weight 0.72 kg (range 0.50-1.27) and median gestational age 26 weeks (range 23-28)) were studied before and after CPAP of 4 cm H(2)O was applied by a facemask system. A multiple-breath nitrogen washout method was used to assess FRC, ventilation, and gas-mixing efficiency. Moment analysis and lung clearance index was calculated from the nitrogen-decay curve for assessment of gas-mixing efficiency. Transcutaneous (Tc) PO(2)/PCO(2) was monitored during stable infant conditions before each washout test. Results: When CPAP was raised from 0 to 4 cm H(2)O, FRC increased significantly together with a significant increase in moment ratios (M(1)/M(0) and M(2)/M(0)). Tc PO(2) decreased significantly and the breathing pattern changed, with significantly reduced respiratory rate, minute ventilation, and alveolar ventilation. There was also an increase in tidal volume and dead space. Conclusions: CPAP of 4 cm H(2)O applied with a facemask at term to infants with BPD did not improve ventilation, gas-mixing efficiency in distal airways, or oxygenation despite an increase in FRC. We speculate that instead of promoting recruitment of unventilated lung volumes, increasing the end-expiratory pressure in infants with BPD may lead to an overexpansion of already ventilated parts of the lung, causing further compromise of lung function.

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