The influence of (non-)invasive artificial ventilation and the level of end expiratory pressure on cerebral and somatic oxygen saturation in preterm infants.

Bijlsma, A. (Alja) (2014) The influence of (non-)invasive artificial ventilation and the level of end expiratory pressure on cerebral and somatic oxygen saturation in preterm infants. thesis, Medicine.

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Abstract

Background: Respiratory distress syndrome (RDS) is a common problem in preterm infants. With RDS, it is often necessary to support the respiration. Different modes of (non-) invasive mechanical ventilation are used for this support. The different ventilation modes and end expiratory pressure (PEEP) could have an influence on the organ blood flow through, for example, an increase of the intrathoracal pressure and therefore a decreased venous return inducing a decreased cardiac output and therefore subsequent lower cerebral blood volume. However, the exact effect of the different ventilation modes and PEEP levels on cerebral and somatic oxygenation and extraction in premature born infants remains unknown. Objective: The aim of this study is to evaluate the effects of different ventilation modes and PEEP in infants with RDS on regional cerebral and somatic (renal and abdominal) oxygen saturation (rcSO2, rrSO2, raSO2) and fractional cerebral, renal and abdominal tissue oxygen extraction (cFTOE, rFTOE, aFTOE) using near infrared spectroscopy (NIRS). Methods: Preterm infants born less than 30 completed weeks of gestational age (GA) or with a birth weight (BW) < 1000 grams or born less than 32 weeks GA and a BW < 1200 grams were included in this study. Exclusion criteria were infants with major congenital or chromosomal malformations. The different ventilation types observed were positive pressure ventilation (PPV), including synchronized intermittent mandatory ventilation (SIMV) and synchronous positive pressure ventilation (SIPPV), nasal intermittent mandatory ventilation (NIMV), nasal continuous positive airway pressure (nCPAP) and minimal ventilatory support (no mechanical ventilation or lowflow). We also take a look at the differences between two groups, namely minimal ventilatory support (no mechanical ventilation or lowflow) and mechanical ventilation (CPAP, NIMV, PPV). The different PEEP-values given were divided in two groups; a group with a low PEEP (< 6 cm H2O) and a group with a high PEEP (≥ 6cm H2O). Multisite NIRS was used 2 hours per day to measure the cerebral and somatic tissue oxygenation on day 2, 3 and 4 after birth. The cerebral NIRS-sensor was placed on the infant’s head, the renal sensor was placed on the left posterior-lateral flank and the abdominal sensor at the infraumbilical abdomen. Results: 44 infants were included with a mean GA of 28 + 1/7 weeks (standard deviation (SD) 1.5) and birth weight median of 1053 grams [560-1735 g]. We found no significant difference in the rcSO2, rrSO2 and raSO2 between different ventilation modes. Infants receiving PPV had a significant lower cFTOE compared to infants on NIMV (0.17 vs. 0.27, p = 0.01) on day four after birth. Infants receiving PPV had a lower aFTOE than infants on minimal ventilatory support (0.16 vs. 0.61, p = 0.04). rcSO2, rrSO2 and raSO2 are not different between infants receiving a high PEEP and infants who received a low PEEP. For cFTOE and rFTOE no difference was seen between the two PEEP groups. A trend is seen for aFTOE between different PEEP-groups, the aFTOE was higher when the preterm received a high PEEP compared to the low PEEP group (0.41 vs. 0.56, p = 0.10) on day 2 after birth. Discussion and Conclusion: We conclude that the most invasive ventilation mode (PPV) in this group of preterm born infants is associated with a lower cerebral and abdominal oxygen extraction. The PEEP level has no influence on the rSO2, except for a tendency of a higher aFTOE when the infant received a higher PEEP. We did not find a clear explanation for this unsuspected result. Our results stresses the need for follow-up research in which more patients will be included to study the exact influences of the different ventilation modes and PEEP levels on the regional oxygen saturation and extraction and to see if there is indeed a higher abdominal oxygen extraction when the infant received less invasive ventilation.

Item Type:	Thesis (Thesis)
Supervisor name:	Kooi, Dr. Elisabeth M.W.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:41
Last Modified:	25 Jun 2020 10:41
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/313

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