Optimal Oxygenation in Neonatal Lung Injury

新生儿肺损伤的最佳氧合

基本信息

批准号：
8522210
负责人：
Satyanarayana Lakshminrusimha
金额：
$ 22.37万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-08-06 至 2017-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8522210
关键词：
Academy Alveolar American American Heart Association Animal Model Antioxidants Asphyxia Birth Blood Vessels Blood flow Brain Cerebrum Coronary Data Defense Mechanisms Disease Ductal Environmental air flow Equilibrium Evaluation Free Radical Formation Future Goals Grant Guidelines Heart Atrium Human Hypoxia Infant Injury Knowledge Left Lung Lung diseases Meconium Aspiration Metabolism Modeling Multicenter Trials Neonatal Intensive Care Newborn Animals Newborn Infant Organ Oxidants Oxidative Stress Oxygen Oxygen Consumption Oxygen Therapy Care Oxygen measurement, partial pressure, arterial Pattern Pediatrics Persistent Fetal Circulation Syndrome Phase Physiological Pregnancy Premature Infant Production Publishing Pulmonary Vascular Resistance Reactive Oxygen Species Recommendation Reporting Respiration Resuscitation Retinopathy of Prematurity Risk Supplementation Syndrome System Testing Tissues Toxic effect Umbilical cord structure Venous base hemodynamics lung injury meetings mortality neonatal lung injury neonatal resuscitation neonate oxygen toxicity programs respiratory respiratory distress syndrome surfactant deficiency translational study uptake

项目摘要

DESCRIPTION (provided by applicant): The American Heart Association recently released guidelines recommending the use of 21% oxygen during initial resuscitation of term newborn infants and use of blended supplemental oxygen to maintain target saturations in premature infants. The American Academy of Pediatrics recommends maintaining PaO2 between 50 and 80 mmHg in the management of sick neonates. These recommendations are based on studies using oxygen saturations in human infants and through translational studies in neonatal animal models without lung disease. Optimal oxygen concentration and target oxygen saturation range during resuscitation and ventilation of preterm and term neonates with lung injury/disease from a standpoint of tissue oxygen delivery and oxygen toxicity is not known. The overall goal of oxygen therapy is to provide adequate oxygen to meet tissue demand without risking oxygen toxicity. The overarching aim of this proposal is to determine the optimal concentration of inspired oxygen during resuscitation and ventilation of a newborn lamb with parenchymal lung disease/ lung injury. Two patterns of neonatal lung injury will be studied in this proposal. In ter lambs injury will be induced by aspiration of meconium during gasping respirations induced as a consequence of umbilical cord occlusion and asphyxia ("asphyxia-MAS" group). Preterm lambs delivered at 126d gestation (term ~ 145d) have parenchymal lung injury as a consequence of surfactant deficiency and respiratory distress syndrome ("preterm-RDS" group). Lambs will be resuscitated and ventilated with 21% oxygen, 100% oxygen or adjusted inspired oxygen concentration to maintain oxygen saturations between 85 to 89%, 90 to 94% or 95 to 99%. The first specific aim of this proposal is to determine the effect inspired oxygen concentration and saturations on oxygenation, lung oxygen uptake and oxygen delivery to the tissues. The second specific aim is to evaluate the effect of oxygen concentration and saturations on pulmonary, cerebral, coronary and ductal hemodynamics and assess delivery of oxygen to various vital organs. We intend to evaluate the risk of oxidant injury in the lung and brain associated with various levels of oxygen through our last specific aim.

描述（由申请人提供）：美国心脏协会最近发布了指南，建议在足月新生儿的初始复苏过程中使用 21% 的氧气，并使用混合补充氧气来维持早产儿的目标饱和度。美国儿科学会建议在处理患病新生儿时将 PaO2 维持在 50 至 80 mmHg 之间。这些建议基于对人类婴儿进行的氧饱和度研究以及对无肺部疾病的新生儿动物模型的转化研究。从组织氧输送和氧毒性的角度来看，患有肺损伤/疾病的早产儿和足月新生儿复苏和通气期间的最佳氧浓度和目标氧饱和度范围尚不清楚。氧疗的总体目标是提供足够的氧气来满足组织需求，而不会有氧中毒的风险。该提案的总体目标是确定患有实质肺病/肺损伤的新生羔羊在复苏和通气期间吸入氧的最佳浓度。本提案将研究新生儿肺损伤的两种模式。在羔羊中，由于脐带闭塞和窒息（“窒息-MAS”组）而引起的喘息呼吸期间胎粪的吸入将引起羔羊损伤。妊娠 126 天（足月 ~ 145 天）分娩的早产羔羊由于表面活性剂缺乏和呼吸窘迫综合征而出现实质肺损伤（“早产 RDS”组）。将用 21% 氧气、100% 氧气或调整吸入氧浓度对羔羊进行复苏和通气，以维持氧饱和度在 85 至 89%、90 至 94% 或 95 至 99% 之间。该提案的第一个具体目标是确定吸入氧浓度和饱和度对氧合、肺吸氧量和组织氧输送的影响。第二个具体目标是评估氧浓度和饱和度对肺、脑、冠状动脉和导管血流动力学的影响，并评估氧输送到各个重要器官的情况。我们打算通过最后一个具体目标来评估与不同氧气水平相关的肺和大脑氧化损伤的风险。