First name
Robin
Middle name
S
Last name
Roberts

Title

Nasal Intermittent Positive Pressure Ventilation Versus Nasal Continuous Positive Airway Pressure to Prevent Primary Noninvasive Ventilation Failure in Extremely Low Birthweight Infants.

Year of Publication

2019

Number of Pages

Date Published

2019 Oct 08

ISSN Number

1097-6833

Abstract

<p>Reducing the risk of primary noninvasive ventilation failure in extremely low birthweight infants is linked to reducing bronchopulmonary dysplasia. In a secondary analysis of randomized data, we identified that failure rates and time to failure were similar for nasal intermittent positive pressure ventilation vs nasal continuous positive airway pressure.</p>

DOI

10.1016/j.jpeds.2019.08.064

Alternate Title

J. Pediatr.

PMID

31604630
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Title

Variation in Positive End-Expiratory Pressure Levels for Mechanically Ventilated Extremely Low Birth Weight Infants.

Year of Publication

2018

Number of Pages

28-33.e5.

Date Published

2018 Mar

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVE: </strong>To test the hypothesis that significant positive end-expiratory pressure (PEEP) level variation exists between neonatal centers.</p>

<p><strong>STUDY DESIGN: </strong>We performed a secondary analysis cohort study of the Nasal Intermittent Positive-Pressure Ventilation trial. Our study population was extremely low birth weight infants requiring mechanical ventilation within 28 days of life. The exposure was neonatal center; 34 international centers participated in the trial. Subjects from centers with fewer than 5 eligible cases were excluded. The main outcome was the maximal PEEP level used during the first course of mechanical ventilation. Infant characteristics judged a priori to directly influence clinical PEEP level selection and all characteristics associated with PEEP at P &lt;.05 in bivariable analyses were included with and without center in multivariable linear regression models. Variation in PEEP level use between centers following adjustment for infant characteristics was assessed.</p>

<p><strong>RESULTS: </strong>A total of 278 extremely low birth weight infants from 17 centers were included. Maximal PEEP ranged from 3 to 9 cm H2O, mean = 5.7 (SD = 0.9). Significant variation between centers remained despite adjustment for infant characteristics (P &lt; .0001). Further, center alone explained a greater proportion of the PEEP level variation than all infant characteristics combined.</p>

<p><strong>CONCLUSIONS: </strong>Marked variation in PEEP levels for extremely low birth weight infants exists between neonatal centers. Research providing evidence-based guidance for this important aspect of respiratory care in preterm infants at high risk of lung injury is needed.</p>

<p><strong>TRIAL REGISTRATION: </strong>ClinicalTrials.govNCT00433212.</p>

DOI

10.1016/j.jpeds.2017.10.065

Alternate Title

J. Pediatr.

PMID

29275926
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Title

Reliability of a Noninvasive Measure of V./Q. Mismatch for Bronchopulmonary Dysplasia.

Year of Publication

2015

Number of Pages

727-33

Date Published

2015 May

ISSN Number

2325-6621

Abstract

<p><strong>RATIONALE: </strong>Currently used definitions of bronchopulmonary dysplasia (BPD) lack a continuous measure of disease severity.</p>

<p><strong>OBJECTIVES: </strong>To determine if an indirect measure of V./Q. mismatch is reliable when simplified to facilitate more widespread use for grading disease severity in BPD at 36 weeks postmenstrual age.</p>

<p><strong>METHODS: </strong>We used prospectively collected data from 32 preterm infants undergoing an oxygen reduction test at 36 weeks postmenstrual age to perform a simplified indirect assessment of V./Q. mismatch for each infant. Independent raters applied the model, and interrater reliability for a quantitative measure of mismatch was measured by intraclass correlation coefficient. A receiver operating characteristic curve evaluated the impact of increasing degrees of V./Q. mismatch on diagnosing BPD as defined by oxygen reduction test failure.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>Concordance for the quantitative measure of V./Q. mismatch between independent raters improved from 0.72 (confidence interval [CI], 0.48-0.86) to 0.93 (CI, 0.87-0.96) after refinement of instructions for applying the simplified model. Higher degrees of mismatch were increasingly predictive of oxygen reduction test failure, with a receiver operating characteristic curve analysis area under the curve of 0.83 (CI, 0.68-0.99; P = 0.03).</p>

<p><strong>CONCLUSIONS: </strong>A simplified indirect measure of V./Q. mismatch for diagnosing and grading disease severity in BPD has high reliability and can be performed with data obtained during a standard oxygen reduction test. This should facilitate more widespread investigation of this model as a technique for characterizing BPD severity.</p>

DOI

10.1513/AnnalsATS.201410-462OC

Alternate Title

Ann Am Thorac Soc

PMID

25714998
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