PT  - JOURNAL ARTICLE
AU  - Nicolas A Bamat
AU  - Carolyn M Orians
AU  - Soraya Abbasi
AU  - Colin J Morley
AU  - Rob Ross Russell
AU  - Howard B Panitch
AU  - Sara C Handley
AU  - Elizabeth E Foglia
AU  - Michael A Posencheg
AU  - Haresh Kirpalani
TI  - Use of ventilation/perfusion mismatch to guide individualised CPAP level selection in preterm infants: a feasibility trial
AID  - 10.1136/archdischild-2022-324474
DP  - 2023 Mar 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - 188--193
VI  - 108
IP  - 2
4099  - http://fn.bmj.com/content/108/2/188.short
4100  - http://fn.bmj.com/content/108/2/188.full
SO  - Arch Dis Child Fetal Neonatal Ed2023 Mar 01; 108
AB  - Objective To measure within-subject changes in ventilation/perfusion (V′/Q′) mismatch in response to a protocol of individualised nasal continuous positive airway pressure (CPAP) level selection.Design Single-arm, non-randomised, feasibility trial.Setting Three centres in the Children’s Hospital of Philadelphia neonatal care network.Patients Twelve preterm infants of postmenstrual age 27–35 weeks, postnatal age >24 hours, and receiving a fraction of inspired oxygen (FiO2) >0.25 on CPAP of 4–7 cm H2O.Interventions We applied a protocol of stepwise CPAP level changes, with the overall direction and magnitude guided by individual responses in V′/Q′ mismatch, as determined by the degree of right shift (kilopascals, kPa) in a non-invasive gas exchange model. Best CPAP level was defined as the final pressure level at which V′/Q′ improved by more than 5%.Main outcome measures Within-subject change in V′/Q′ mismatch between baseline and best CPAP levels.Results There was a median (IQR) within-subject reduction in V′/Q′ mismatch of 1.2 (0–3.2) kPa between baseline and best CPAP levels, p=0.02. Best CPAP was observed at a median (range) absolute level of 7 (5–8) cm H2O.Conclusions Non-invasive measures of V′/Q′ mismatch may be a useful approach for identifying individualised CPAP levels in preterm infants. The results of our feasibility study should be interpreted cautiously and replication in larger studies evaluating the impact of this approach on clinical outcomes is needed.Trial registration number NCT02983825.Data are available upon reasonable request. Please contact corresponding author.