title: Effectivity of ventilation by measuring expired CO2 and RIP during stabilisation of preterm infants at birth.
abstract: OBJECTIVE
  To measure tidal volume, plethysmography changes and gas exchange during respiratory support at birth.
  
  
  METHODS
  The following parameters were measured: (1) expired tidal volumes (Vte (mL/kg)) using respiratory function monitoring, (2) changes in plethysmography (AU/kg) per breath using respiratory inductance plethysmography (bands placed around rib cage (RC) and abdomen (AB)) and (3) expired CO2 (ECO2) levels using a volumetric CO2 monitor. For respiratory support, a T-piece resuscitator and facemask were used with peak inspiratory pressure (PIP) 25 cm H2O and positive end expiratory pressure 5 cm H2O. Data were analysed during the sustained inflation (SI), positive pressure ventilation (PPV) and breathing on continuous positive airway pressure (CPAP).
  
  
  METHODS
  The delivery rooms of the Leiden University Medical Center, Leiden, and V. Buzzi, Milan.
  
  
  METHODS
  15 preterm infants with a gestational age 28 (27-31) weeks and a birth weight of 1080 (994-1300) g.
  
  
  RESULTS
  Vte for PPV inflations, PPV inflations with breathing and spontaneous breathing were significantly different (4.4 (2.5-8.6) vs 8.8 (5.7-11.4) vs 5.7 (3.3-9.8); p<0.0001)). Spontaneous breathing led to the highest ECO2 levels and during PPV, ECO2 levels were higher when the inflations coincided with breathing (32 (23-38) vs 20 (13-25) vs 2 (3-11) mm Hg; p<0.0001). Little change in plethysmography amplitude occurred during the SI, PPV and breathing at the RC. There was gain in plethysmography amplitude at the AB during the SI, PPV, but most with breathing.
  
  
  CONCLUSIONS
  While Vte during breathing on CPAP was lower compared with PPV coinciding with breathing, breathing on CPAP was most effective in gas exchange and plethysmography amplitude gain compared with PPV and PPV coinciding with breathing.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: van Vonderen
authors.affiliation: Department of Neonatology, V. Buzzi Children's Hospital ICP, Milan, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.affiliation: Department of Neonatology, V. Buzzi Children's Hospital ICP, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavigioli
authors.affiliation: The Ritchie Center, Monash institute for Medical Research, Monash University, Melbourne, Victoria, Australia.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Hooper
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D002245:Carbon Dioxide / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010991:Plethysmography / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012119:Respiration; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide
keywords: CO2; breathing; expiratory tidal volume; neonatal transition; respiratory inductance plethysmography