TY - JOUR
TI - Ventilation With or Without Endotracheal Tube Leak in Prolonged Neonatal
Asphyxia
AU - Douvanas, Alexandros
AU - Kalafati, Maria
AU - Tamvaki, Eleni
AU - Nieri,
AU - Alexandra
AU - Papalois, Apostolos
AU - Koulouglioti, Christina and
AU - Aggelina, Afrodite
AU - Papathanassoglou, Elizabeth
JO - CUREUS
PY - 2021
VL - 13
TODO - 9
SP - null
PB - CUREUS INC
SN - null
TODO - 10.7759/cureus.17798
TODO - newborn piglet model; neonatal asphyxia; perinatal asphyxia;
endotracheal tube leakage; neonatal resuscitation; birth respiratory
support; swine models; return of spontaneous circulation
TODO - Background
Severe and prolonged asphyxia can result in either intrauterine fetal
death and stillbirth or multiorgan failure in surviving neonates.
Establishing effective ventilation is the primary aim of resuscitation
in newborns with asphyxia. The objective of this study was to compare
the outcome of resuscitation by applying an endotracheal tube (ETT) with
less, an ETT with moderate, and an ETT with high leakage during
mechanical ventilation in swine neonates after prolonged perinatal
asphyxia.
Materials and methods
A prospective, randomized controlled laboratory study was performed.
Thirty Landrace/large white pigs, aged one to four days and weighted
1.754 +/- 218 gr, were randomly allocated into three groups depending on
the ETT size: Group C (less leak: ETT no 4.0, n=10); Group A (high leak:
ETT no 3.0, n=10); and Group B (moderate leak: ETT no 3.5, n=10).
Mechanical asphyxia was performed until their heart rate was less than
60 bpm or their mean arterial pressure was below 15 mmHg. All animals
with return of spontaneous circulation (ROSC) were monitored for four
hours for their hemodynamic parameters, arterial oxygen saturation, and
lactate acid levels.
Results
We demonstrate that 70% of the surviving animals were ventilated with
an ETT with a leak (no. 3.5 and 3). A statistically significant
difference was noted in PO2 (p=0.032) between Group B (126.4 +/- 53.4
mmHg) compared to Group A (72.28 +/- 29.18 mmHg) and Group C (94.28 +/-
20.46 mmHg) as well as in the right atrial pressure (p<0.001) between
Group C (4.5 mmHg) vs Groups A (2 mmHg) and B (2 mmHg) during ROSC time.
Lactate levels were statistically significantly lower (p=0.035) in Group
C (mean=0.92 +/- 0.07mmol/L) as compared to Group A (mean=1.13 +/- 0.1
mmol/L) and Group B (mean=1.08 +/- 0.07 mmol/L; p = 0.034) at 4h
post-ROSC.
Conclusion
We provide preliminary evidence that ventilation with ETT with moderate
leakage improves survival after 2h of ROSC, along with oxygenation and
hemodynamic parameters, in a porcine model of neonatal asphyxia and
resuscitation, compared to less leakage ETT.
ER -