Related Experiment Videos
Peak inspiratory pressure requirements in infants born weighing less than 750 g
Insights
Peak inspiratory pressure in premature infants can predict respiratory outcomes. High pressure requirements indicate a higher risk of death from respiratory causes, suggesting initial lung disease severity is key.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Predicting clinical outcomes in extremely low birth weight infants is crucial.
- Respiratory complications are a major cause of mortality in these infants.
- Identifying reliable prognostic markers is essential for timely intervention.
Purpose of the Study:
- To investigate if peak inspiratory pressure (PIP) or arterial:alveolar oxygen ratio can predict respiratory outcomes in infants <750g.
- To establish a 95th centile for PIP during the first 72 hours of life.
- To evaluate the predictive value of this PIP centile for later respiratory mortality.
Main Methods:
- Retrospective analysis of consecutive infant series.
- Calculation of PIP at 48 and 72 hours of age.
- Construction of a 95th centile for PIP.
- Validation of the PIP centile in a separate infant cohort.
- Comparison of radiological findings and arterial carbon dioxide pressure between survivors and non-survivors.
Main Results:
- Infants with PIP >18 cm H2O at 48h or >16 cm H2O at 72h had a 90% mortality rate from respiratory causes.
- 95% of infants with lower PIP requirements survived.
- A PIP requirement exceeding the 95th centile predicted later respiratory death with 92% accuracy.
- Infants who died showed more severe radiological changes and higher arterial carbon dioxide pressure.
- PIP was a more effective predictor than the arterial:alveolar oxygen ratio.
Conclusions:
- PIP is a valuable predictor of respiratory outcomes in very low birth weight infants.
- High PIP requirements suggest severe underlying lung disease, impacting prognosis.
- The 95th centile for PIP can aid in identifying infants at high risk for respiratory mortality.
Abstract:
The possibility that peak inspiratory pressure requirements or the arterial:alveolar oxygen ratio can predict the clinical outcome in infants weighing less than 750 g at birth was explored in a consecutive series. Nine of 10 infants (90%) with a peak inspiratory pressure requirement of more than 18 cm H2O at 48 hours or more than 16 cm H2O at 72 hours from age subsequently died later of respiratory causes (defined as death after 72 hours of pulmonary interstitial emphysema, bronchopulmonary dysplasia, or cor pulmonale). Twenty of 21 remaining infants (95%) survived until discharge. Using these data a 95th centile for peak inspiratory pressure requirement during the first 72 hours of life was constructed. The potential value of this centile in predicting later death of respiratory causes was examined in a separate series. Twelve of 15 infants (80%) whose peak inspiratory pressure requirements remained below the 95th centile, or were not ventilated (n = 6), survived. In contrast, 11 of 12 (92%) infants whose requirements crossed the 95th centile died later of respiratory causes. The infants who died had more radiological changes and higher mean arterial carbon dioxide pressure than survivors suggesting that the severity of the initial lung disease rather than the way that ventilation was managed determined prognosis. Peak inspiratory pressure requirement was more useful than arterial:alveolar oxygen ratio in clearly distinguishing between survivors and infants who died later of respiratory causes.