Abstract
BackgroundSevere 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 methodsA 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.ResultsWe 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.ConclusionWe 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.
Highlights
In most cases, the transition to extrauterine life in term babies occurs naturally, without any assistance
We used a swine model of perinatal asphyxia, as newborn piglets are equivalent to human infants at 36-38 weeks of gestational age and have a comparable size and weight (1.5-2 kg body weight), allowing easy instrumentation to invasively monitor hemodynamic parameters, blood gases, and physiological measurements, as well as the ability to monitor the degree of hypoxia-asphyxia and reoxygenation in the recovery phase [14]
In the group with minimal leakage compared to the groups with leakage, fewer piglets were successfully resuscitated and survived past two hours post-return of spontaneous circulation (ROSC), suggesting that effective respiratory support and survival can be achieved with endotracheal tube (ETT) leakage ventilation
Summary
The transition to extrauterine life in term babies occurs naturally, without any assistance. Perinatal asphyxia is defined as the interruption of blood flow or oxygen deprivation to and from the fetus around the time of birth. It may be caused by maternal or fetal hemorrhage, intermittent or acute umbilical cord compression, uterine rupture, or shoulder dystocia, which influence the supply of oxygenated blood to the fetus [2]. It is characterized by intermittent periods of hypoxia-ischemia that, if prolonged and intense enough, may cause irreversible. 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
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