4.5 Article

Early extubation to noninvasive respiratory support of former preterm lambs improves long-term respiratory outcomes

Publisher

AMER PHYSIOLOGICAL SOC
DOI: 10.1152/ajplung.00051.2021

Keywords

alveolar formation; bronchopulmonary dysplasia; mechanical ventilation; neonatal chronic lung disease; pulmonary function

Funding

  1. National Institutes of Health (NIH) [R01-HL110002, R01-HL062875, T35 HL07744]
  2. Division of Neonatology

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Limiting the duration of invasive mechanical ventilation following preterm birth can lead to better respiratory system mechanics and structural outcomes in later life, as shown through a study on preterm lambs.
Invasive mechanical ventilation (IMV) and exposure to oxygen-rich gas during early postnatal life are contributing factors for long-term pulmonary morbidities faced by survivors of preterm birth and bronchopulmonary dysplasia. The duration of IMV that leads to long-term pulmonary morbidities is unknown. We compared two durations of IMV (3 h vs. 6 days) during the first 6-7 days of postnatal life in preterm lambs to test the hypothesis that minimizing the duration of IMV will improve long-term respiratory system mechanics and structural outcomes later in life. Moderately preterm (similar to 85% gestation) lambs were supported by IMV for either 3 h or 6 days before weaning from all respiratory support to become former preterm lambs. Respiratory system mechanics and airway reactivity were assessed monthly from 1 to 6 mo of chronological postnatal age by the forced oscillation technique. Quantitative morphological measurements were made for smooth muscle accumulation around terminal bronchioles and indices of alveolar formation. Minimizing IMV to 3 h led to significantly better (P < 0.05) baseline respiratory system mechanics and less reactivity to methacholine in the first 3 mo of chronological age (2 mo corrected age), significantly less (P < 0.05) accumulation of smooth muscle around peripheral resistance airways (terminal bronchioles), and significantly better (P < 0.05) alveolarization at the end of 5 mo corrected age compared with continuous IMV for 6 days. We conclude that limiting the duration of IMV following preterm birth of fetal lambs leads to better respiratory system mechanics and structural outcomes later in life.

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