Objectives To determine the regional ventilation characteristics during non-invasive ventilation (NIV) in stable preterm infants. The secondary aim was to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status. Design Prospective observational study. Setting Two tertiary neonatal intensive care units. Patients Forty stable preterm infants born <30 weeks of gestation receiving either continuous positive airway pressure (n=32) or high-flow nasal cannulae (n=8) at least 24 hours after extubation at time of study. Interventions Continuous electrical impedance tomography imaging of regional ventilation during 60 min of quiet breathing on clinician-determined non-invasive settings. Main outcome measures Gravity-dependent and right–left centre of ventilation (CoV), percentage of whole lung tidal volume (VT) by lung region and percentage of lung unventilated were determined for 120 artefact-free breaths/infant (4770 breaths included). Oxygen saturation, heart and respiratory rates were also measured. Results Ventilation was greater in the right lung (mean 69.1 (SD 14.9)%) total VT and the gravity-non-dependent (ND) lung; ideal–actual CoV 1.4 (4.5)%. The central third of the lung received the most VT, followed by the non-dependent and dependent regions (p<0.0001 repeated-measure analysis of variance). Ventilation inhomogeneity was associated with worse peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (p=0.031, r2 0.12; linear regression). In those infants that later developed bronchopulmonary dysplasia (n=25), SpO2/FiO2 was worse and non-dependent ventilation inhomogeneity was greater than in those that did not (both p<0.05, t-test Welch correction). Conclusions There is high breath-by-breath variability in regional ventilation patterns during NIV in preterm infants. Ventilation favoured the ND lung, with ventilation inhomogeneity associated with worse oxygenation. Data are available upon reasonable request. Deidentified individual participant data, study protocols and statistical analysis codes are available from 3 months to 23 years following article publication to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary'). Proposals should be directed to david.tingay@mcri.edu.au to gain access. Data requestors will need to sign a data access or material transfer agreement approved by the Murdoch Children's Research Institute.

中文翻译：

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早产儿无创呼吸支持期间的区域通气特征

目的 确定稳定早产儿无创通气 (NIV) 期间的区域通气特性。次要目的是探索通气均匀性指标与其他呼吸状态临床测量指标之间的关系。设计前瞻性观察研究。设置两个三级新生儿重症监护病房。患者 在研究时拔管后至少 24 小时接受持续气道正压通气 (n=32) 或高流量鼻插管 (n=8) 的 40 名稳定早产儿出生 <30 周。干预 在临床医生确定的非侵入性环境下进行 60 分钟的安静呼吸期间区域通气的连续电阻抗断层扫描成像。主要结果测量重力依赖和左右通气中心 (CoV)，确定了 120 次无伪影呼吸/婴儿（包括 4770 次呼吸）的肺区域的全肺潮气量 (VT) 百分比和未换气肺的百分比。还测量了氧饱和度、心脏和呼吸频率。结果 右肺的通气量更大（平均 69.1 (SD 14.9)%）总 VT 和重力非依赖性 (ND) 肺；理想-实际 CoV 1.4 (4.5)%。肺的中央三分之一接受了最多的 VT，其次是非依赖性和依赖性区域（p<0.0001 重复测量方差分析）。通气不均匀性与较差的外周毛细血管氧饱和度 (SpO2)/吸入氧浓度 (FiO2) 相关（p=0.031，r2=0.12；线性回归）。在那些后来发展为支气管肺发育不良的婴儿 (n=25) 中，SpO2/FiO2 更差，非依赖性通气不均匀性大于那些不依赖的通气不均匀性（两者 p<0.05，t 检验 Welch 校正）。结论 早产儿 NIV 期间区域通气模式的每次呼吸变化很大。通气有利于 ND 肺，通气不均匀性与氧合较差相关。可应合理要求提供数据。在文章发表后 3 个月至 23 年内，经过独立审查委员会（“学习中介”）批准，提供方法论上合理的建议的研究人员可以使用去标识化的个人参与者数据、研究方案和统计分析代码。应将提案发送至 david.tingay@mcri.edu.au 以获取访问权限。