Invasive mechanical ventilation in the delivery room: is it always worthwhile?

Aleksandrovich Yu.S.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia

Pshenisnov K.V.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia

Chijenas V.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia;
Vilnius maternity hospital;
Tyzenhauzu 18A, Vilnius, Lithuania

Prometnoy D.V.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia;
Rostov State Medical University under the Ministry of Health of of the Russian Federation, 29 Nakhichevansky per., Rostov-on-Don, 344022;
Russia

Aleksandrovich I.V.

I.I. Mechnikov North-Western State Medical University under the Ministry of Health of the Russian Federation, 41 Kirochnaya str., Saint-Petersburg, 191015, Russia

Pilipene I.

Obstetrics and Gynecology Center, Santaros Clinic of the Vilnius University, Santariskiu 2, 08661 Vilnius, Lithuania

Invasive mechanical ventilation in the delivery room: is it always worthwhile?

Authors:

Aleksandrovich Yu.S., Pshenisnov K.V., Chijenas V., Prometnoy D.V., Aleksandrovich I.V., Pilipene I.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2018;(5): 44‑52

DOI: 10.17116/anaesthesiology201805144

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To cite this article:

Aleksandrovich YuS, Pshenisnov KV, Chijenas V, Prometnoy DV, Aleksandrovich IV, Pilipene I. Invasive mechanical ventilation in the delivery room: is it always worthwhile?. Russian Journal of Anesthesiology and Reanimatology. 2018;(5):44‑52. (In Russ.)
https://doi.org/10.17116/anaesthesiology201805144

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Optimization of respiratory support for newborns immediately after the birth is one of the difficult problems of modern neonatology and intensive care for newborns. The purpose of the study is to optimize the respiratory support in delivery room by studying the prognostic significance of specific characteristics of the pregnancy course, delivery, clinical and laboratory status and by identifying the risk factors for initiation of invasive mechanical ventilation in preterm infants. Material and methods. 99 newborns were examined. The average weight of the babies was 1650 (1300—1690) g; the gestation period was 31 (30—34) weeks; the 1-minute Apgar scoring was 6 (5—7), and the 5-minute scoring was 6 (6—8). Depending on the method of respiratory support in the delivery room, all the infants were divided into two groups: group I (n=40) received non-invasive respiratory support (nasal CPAP); group II (n=59) received invasive respiratory support (MV). The respiratory distress syndrome severity assessment was carried out according to the Silverman scale. Results. In the first group, most respiratory disorders were caused by extrapulmonary factors (57.5% vs 5.1%, OR=0.0); in the second group, the infant respiratory distress syndrome was the leading cause of the respiratory disorders (40.0% vs 93.2%; OR=20.6). Combined non-respiratory pathology was more common in group II (96.6% vs 52.5%) and it led to a statistically significant increase in the likelihood of invasive respiratory support in the delivery room (OR=25.8). The highest probability of invasive mechanical ventilation was observed in patients with cerebral pathology (OR=161.5); to a lesser extent, it was noted in patients with infectious pathology (OR=3.6) and with heart and blood diseases (OR=3.4). Risk factors for the development of a severe respiratory failure, which may require an invasive mechanical ventilation, include retardation, metabolic disorders, lactate acidosis and hypoglycemia. Conclusion. The use of invasive mechanical ventilation in preterm infants with mild and moderate respiratory distress symptoms is not recommended; non-invasive respiratory support by nasal CPAP is the method of choice.

Keywords:

respiratory distress

newborns

premature newborns

non-invasive respiratory support

nasal continuous positive airway pressure (nCPAP)

invasive mechanical ventilation

Authors:

Aleksandrovich Yu.S.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia

Pshenisnov K.V.

Saint-Petersburg State Pediatric Medical University under the Ministry of Health of the Russian Federation, 2 Litovskaya str., Saint-Petersburg, 194100, Russia

Chijenas V.

Prometnoy D.V.

Aleksandrovich I.V.

I.I. Mechnikov North-Western State Medical University under the Ministry of Health of the Russian Federation, 41 Kirochnaya str., Saint-Petersburg, 191015, Russia

Pilipene I.

Obstetrics and Gynecology Center, Santaros Clinic of the Vilnius University, Santariskiu 2, 08661 Vilnius, Lithuania

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