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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
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Tidal volume optimization and heart rate response during stabilization of very preterm infants

Francesco Cavigioli1, Ilia Bresesti1,2, Antonio Di Peri1

  • 1NICU "V. Buzzi" Children's Hospital, ASST-FBF-Sacco, Milan, Italy.

Pediatric Pulmonology
|November 3, 2022
PubMed

Insights

Respiratory function monitors (RFM) help tailor ventilation for preterm infants by correlating heart rate (HR) rise with adequate tidal volumes. This technology allows real-time adjustments to lung compliance during stabilization.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Medical Device Technology

Background:

  • Preterm infants often require respiratory support at birth.
  • Assessing ventilation effectiveness and heart rate (HR) changes during stabilization is critical.
  • Current methods may not provide real-time feedback on ventilation adequacy.

Purpose of the Study:

  • To evaluate the added value of a respiratory function monitor (RFM) in assessing ventilation.
  • To correlate RFM data with heart rate (HR) changes during the stabilization of preterm infants.
  • To determine if RFM can guide ventilation adjustments based on real-time physiological responses.

Main Methods:

  • Inclusion of preterm infants (<32 weeks' gestation) needing positive pressure ventilation (PPV).
  • Monitoring the first 15 minutes of stabilization using RFM.
  • Analyzing respiratory parameters (PIP, PEEP, MAP, Vte/kg, Cdyn) at three time points based on HR response.

Main Results:

  • Significant increases in Peak Inspiratory Pressure (PIP) and Mean Airway Pressure (MAP) were observed as HR increased.
  • Expired tidal volume per kilogram (Vte/kg) was significantly lower at the start of PPV compared to later time points.
  • Dynamic lung compliance (Cdyn) showed a significant effect of time, indicating changing respiratory mechanics.

Conclusions:

  • A direct correlation exists between heart rate (HR) improvement and adequate expired tidal volume (Vte/kg) in stabilizing preterm infants.
  • Respiratory function monitors (RFM) show potential for optimizing ventilation strategies.
  • RFM can facilitate real-time adjustments to ventilation based on lung compliance changes.
Abstract

Keywords:
bradycardiapositive pressure ventilationpreterm infantsrespiratory function monitorstabilization

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