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The DELUX study: development of lung volumes during extubation of preterm infants

OBJECTIVE: To measure changes in end-expiratory lung impedance (EELI) as a marker of functional residual capacity (FRC) during the entire extubation procedure of very preterm infants. METHODS: Prospective observational study in preterm infants born at 26–32 weeks gestation being extubated to non-inv...

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Autores principales: Plastina, Leonie, Gaertner, Vincent D., Waldmann, Andreas D., Thomann, Janine, Bassler, Dirk, Rüegger, Christoph M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406659/
https://www.ncbi.nlm.nih.gov/pubmed/34465873
http://dx.doi.org/10.1038/s41390-021-01699-w
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author Plastina, Leonie
Gaertner, Vincent D.
Waldmann, Andreas D.
Thomann, Janine
Bassler, Dirk
Rüegger, Christoph M.
author_facet Plastina, Leonie
Gaertner, Vincent D.
Waldmann, Andreas D.
Thomann, Janine
Bassler, Dirk
Rüegger, Christoph M.
author_sort Plastina, Leonie
collection PubMed
description OBJECTIVE: To measure changes in end-expiratory lung impedance (EELI) as a marker of functional residual capacity (FRC) during the entire extubation procedure of very preterm infants. METHODS: Prospective observational study in preterm infants born at 26–32 weeks gestation being extubated to non-invasive respiratory support. Changes in EELI and cardiorespiratory parameters (heart rate, oxygen saturation) were recorded at pre-specified events during the extubation procedure compared to baseline (before first handling of the infant). RESULTS: Overall, 2912 breaths were analysed in 12 infants. There was a global change in EELI during the extubation procedure (p = 0.029). EELI was lowest at the time of extubation [median (IQR) difference to baseline: −0.30 AU/kg (−0.46; −0.14), corresponding to an FRC loss of 10.2 ml/kg (4.8; 15.9), p(adj) = 0.004]. The biggest EELI loss occurred during adhesive tape removal [median change (IQR): −0.18 AU/kg (−0.22; −0.07), p(adj) = 0.004]. EELI changes were highly correlated with changes in the SpO(2)/FiO(2) ratio (r = 0.48, p < 0.001). Forty per cent of FRC was re-recruited at the tenth breath after the initiation of non-invasive ventilation (p < 0.001). CONCLUSIONS: The extubation procedure is associated with significant changes in FRC. This study provides novel information for determining the optimal way of extubating a preterm infant. IMPACT: This study is the first to examine the development of lung volumes during the entire extubation procedure including the impact of associated events. The extubation procedure significantly affects functional residual capacity with a loss of approximately 10 ml/kg at the time of extubation. Removal of adhesive tape is the major contributing factor to FRC loss during the extubation procedure. Functional residual capacity is regained within the first breaths after initiation of non-invasive ventilation and is further increased after turning the infant into the prone position.
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spelling pubmed-84066592021-08-31 The DELUX study: development of lung volumes during extubation of preterm infants Plastina, Leonie Gaertner, Vincent D. Waldmann, Andreas D. Thomann, Janine Bassler, Dirk Rüegger, Christoph M. Pediatr Res Clinical Research Article OBJECTIVE: To measure changes in end-expiratory lung impedance (EELI) as a marker of functional residual capacity (FRC) during the entire extubation procedure of very preterm infants. METHODS: Prospective observational study in preterm infants born at 26–32 weeks gestation being extubated to non-invasive respiratory support. Changes in EELI and cardiorespiratory parameters (heart rate, oxygen saturation) were recorded at pre-specified events during the extubation procedure compared to baseline (before first handling of the infant). RESULTS: Overall, 2912 breaths were analysed in 12 infants. There was a global change in EELI during the extubation procedure (p = 0.029). EELI was lowest at the time of extubation [median (IQR) difference to baseline: −0.30 AU/kg (−0.46; −0.14), corresponding to an FRC loss of 10.2 ml/kg (4.8; 15.9), p(adj) = 0.004]. The biggest EELI loss occurred during adhesive tape removal [median change (IQR): −0.18 AU/kg (−0.22; −0.07), p(adj) = 0.004]. EELI changes were highly correlated with changes in the SpO(2)/FiO(2) ratio (r = 0.48, p < 0.001). Forty per cent of FRC was re-recruited at the tenth breath after the initiation of non-invasive ventilation (p < 0.001). CONCLUSIONS: The extubation procedure is associated with significant changes in FRC. This study provides novel information for determining the optimal way of extubating a preterm infant. IMPACT: This study is the first to examine the development of lung volumes during the entire extubation procedure including the impact of associated events. The extubation procedure significantly affects functional residual capacity with a loss of approximately 10 ml/kg at the time of extubation. Removal of adhesive tape is the major contributing factor to FRC loss during the extubation procedure. Functional residual capacity is regained within the first breaths after initiation of non-invasive ventilation and is further increased after turning the infant into the prone position. Nature Publishing Group US 2021-08-31 2022 /pmc/articles/PMC8406659/ /pubmed/34465873 http://dx.doi.org/10.1038/s41390-021-01699-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Clinical Research Article
Plastina, Leonie
Gaertner, Vincent D.
Waldmann, Andreas D.
Thomann, Janine
Bassler, Dirk
Rüegger, Christoph M.
The DELUX study: development of lung volumes during extubation of preterm infants
title The DELUX study: development of lung volumes during extubation of preterm infants
title_full The DELUX study: development of lung volumes during extubation of preterm infants
title_fullStr The DELUX study: development of lung volumes during extubation of preterm infants
title_full_unstemmed The DELUX study: development of lung volumes during extubation of preterm infants
title_short The DELUX study: development of lung volumes during extubation of preterm infants
title_sort delux study: development of lung volumes during extubation of preterm infants
topic Clinical Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8406659/
https://www.ncbi.nlm.nih.gov/pubmed/34465873
http://dx.doi.org/10.1038/s41390-021-01699-w
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