nCPAP transfer
Description
Noninvasive respiratory support is a crucial component of neonatal respiratory distress syndrome therapy. The nCPAP (nasal continuous positive airway pressure) is recommended as an initial for respiratory support of a premature baby. However, there is no consensus in the literature on the possibility, conditions and criteria for non-invasive respiratory support for newborns during inter-hospital transportation, and the recommendations are empirical. Objective: To study the possibility of carrying out nCPAP during pre-transport preparation and inter-hospital transportation of newborns. Materials and Methods: the observational, cohort, retrospective study included data on 70 cases of evacuation of newborns performed by the transport team of the resuscitation advisory Center of the Regional Children's Clinical Hospital of Yekaterinburg in the period from July 1, 2014 to December 31, 2018 to patients who were on noninvasive ventilation (nCPAP) at the time of examination by the transport team in the initial medical organization. The initial sample was divided into a group of patients transported to a ventilator (n=22) and a group of patients transported to nCPAP (n=47), respiratory support was discontinued in one case. Results: analyzing the parameters of respiratory support at the time of examination by the transport team, statistically significant differences were observed between the oxygen fraction groups (34% (30-45) and 30% (21-30), the first and second groups, respectively, p=0.002) and the saturation index of oxygenation (2.14 (1.55 - 2.58) and 1.53 (1.31 - 1.84)) the first and second groups, respectively, p = 0.001). The saturation index of oxygenation has an acceptable predictive value in for tracheal intubation at the stage of pre–transport preparation (AUC 0.799 [0.682 - 0.917]). During transportation, one patient of the second group required tracheal intubation (2,13%[0,05 - 11,29]). Upon admission, one patient of the second group needed to perform tracheal intubation (2,17%[0,06 – 11,53]), no other correction of the parameters of noninvasive support was required for patients of the second group. Conclusion: The main criterion for the transfer to a ventilator at the stage of pre-transport preparation is the dependence on additional oxygen during the nCPAP. The saturation oxygenation index (AUC 0.799 [0.682 – 0.917]) and the SpO2/FiO2 ratio (0.803 [0.687 – 0.919]) have an acceptable predictive value in relation to the need for tracheal intubation. The probability of intubation during transportation is 2.13% [0.05 - 11.29].
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The observational, cohort, retrospective study included data from 70 cases of evacuation of newborns performed by the transport team to patients who were on nCPAP at the time of examination by the resuscitator of the transport team in the initial medical organization. After examining the patients by the resuscitator of the transport team, in 22 cases (31.43%), a decision was made to intubate the trachea and carry out transportation on a ventilator, in one case (1.43%), a decision was made to discontinue non-invasive support and transport the child on spontaneous breathing without additional pressure in the upper respiratory tract. Thus, the initial sample was divided into a group of patients transported to the ventilator (n=22) and a group of patients transported to the nCPAP (n=47). The general scheme of the study is shown in Figure 1. The data source was primary medical documentation. The transport complex included: incubator transport ITN-1 (UOMZ, Yekaterinburg, Russia), ventilator transport Stephan F120 Mobile (Stephan, Germany), syringe dispenser B.Braun Perfusor Compact S (B. Braun, Germany), Philips MP 40 patient monitor (Philips Medizin Systeme Boblingen GmbH, Germany), At the preparation stage, monitoring and respiratory support was carried out by the equipment of the transport complex. Noninvasive ventilation (nCPAP) was performed using a mononasal cannula. Anamnesis data, respiratory support parameters, monitoring parameters at all stages, outcomes of inpatient treatment were analyzed. The calculation of the saturation oxygenation index for noninvasive respiratory support was performed as follows: [FiO2 x CPAP]/SpO2. Methods of descriptive statistics: median and interquartile interval, fraction, 95% CI fraction. The hypothesis about the normality of the sample distribution was tested by the Shapiro–Wilk method. In the analysis of binary indicators of two independent groups, the exact Fisher criterion was applied, in the analysis of quantitative data of independent groups, the Mann-Whitney criterion was applied. When analyzing quantitative parameters in dependent samples, the Wilcoxon criterion was applied. ROC analysis was performed with the calculation of the area under the ROC curve, sensitivity, specificity, cut-off level, positive predictive value (PPV) and negative predictive value (NPV), the Yuden index. The calculation of the odds ratio is applied when comparing the probability of an outcome between groups. The differences were considered statistically significant at p<0.05. Software tools BioStas Pro 7.0.1.0. (AnalystSoft Inc. USA) and Matlab R2017a. (The MathWorks, Inc. USA).