Opportunity for invasive mechanical ventilation in NRDS: a retrospective cohort study in China

Mechanical ventilation, as a critical breathing support, plays a critical role in the treatment of neonatal respiratory distress syndrome (NRDS). We aim to describe the clinical characteristics of NRDS and give suggestions about when to start mechanical ventilation.

We conducted a retrospective cohort study, enrolling 95 neonates between December 2016 and October 2021. Diagnosis of NRDS was according to the Berlin definition. Spearman's and ROC analysis was used to determine the variables correlated with hospital stay and optimal opportunity for mechanical ventilation.

Ninety-five subjects with NRDS were included. Lower PaO₂ and higher PaCO₂ in arterial blood gas prompt longer discharge time after mechanical ventilation and total in-hospital stay (p < .05), in which significant correlations were identified in Spearman's analysis. ROC analysis illustrated that mechanical ventilation starting when PaO₂ was 52.5 mmHg contributed to the shortest discharge time and in-hospital stay. PaCO₂ of 45.4 mmHg was another optimal cut-off value for the initiation of mechanical ventilation with an AUC of 0.636 (sensitivity 91.5%, specificity 29.2%, p = .022).

PaO₂ and PaCO₂ were significantly correlated with discharge time and in-hospital stays. When PaO₂ was reduced to 52.5 mmHg or PaCO₂ increased to 45.5 mmHg, mechanical ventilation was strongly recommended.