Clinical Study Of Prone Position Ventilation In The Treatment Of Neonatal Respiratory Distress Syndrome

ObjectivesThis study was to investigate the use of prone position ventilation and non-invasive percutaneous blood gas monitoring in Neonatal Respiratory Distress Syndrome（NRDS）.In addition,ROC curves were drawn to NRDS.To study the accuracy of the percutaneous partial pressure of carbon dioxide（PCO₂）for 3 hours in prone position in predicting whether neonates could withdraw the machine after 3 days.In order to improve the poor prognosis,high cost and unpredictability of NRDS neonates exposed to mechanical ventilation in the Neonatal Intensive Care units（NICU）,scientific reference can be provided for predicting the development of NRDS neonates in the neonatal intensive care units（NICU）.MethodsThrough the design of a controlled clinical experiment,NRDS neonates admitted to NICU of Neonatology Department of Hubei Third People’s Hospital from August 2020 to December 2022 were selected and divided into two groups:conventional supine position and prone position.30 cases were retrospectively collected in the control group and 30 cases were prospectively collected in the observation group.Tracheal intubation mechanical ventilation was used in both groups,and the nursing and treatment plans were the same except for different positions.The observation group was ventilated in prone position after endotracheal intubation and mechanical ventilation.In addition to routine nursing,the patients were given prone position intermittently for 9h every day for 3h each time,and supine position was given after the end.The control group received conventional mechanical ventilation in supine position,and was alternately given supine position,left and right supine position.Both groups were given back patting and percutaneous blood gas monitoring after each change of body position.The duration of mechanical ventilation,the duration of oxygen use,the duration of hospitalization in NICU and the related complications were compared between the two groups.Changes of Trans-cutaneous partial pressure of carbon dioxide（TcPCO₂）at different time points within 3 days of mechanical ventilation.The ROC curve was used to evaluate the accuracy of TcPCO₂in predicting whether neonates could withdraw the machine after 3 days.Results1.A total of 51 neonates with NRDS were included in the study,but 9 neonates withdrew from the study due to various reasons,including 5 neonates who died after their families gave up treatment complicated with multiple organ failure（2 cases in the observation group and 3 cases in the control group）,and 2 neonates who withdrew from the study due to their families’request for transfer to hospitals（1 case in the observation group and 1 case in the control group）.Two neonates dropped out of the study due to partial absence of percutaneous blood gas data（2 patients in the control group）.Therefore,only 42neonates actually completed this study,including 18 in the observation group and 24 in the control group.2.Gestational age,birth weight,gender,mode of delivery,asphyxia at birth,maternal history of diabetes,age at admission,respiration,heart rate,admission blood gas indexes（Pa O₂and Pa CO₂）were compared between the two groups,and there was no statistical significance（P>0.05）.Therefore,the two groups of neonates were comparable.3.The common risk factors for NRDS are preterm birth,elective cesarean section,gestational diabetes history of the mother,asphyxia history at birth and male neonates.In the two groups,there were 2 neonates without the above high risk factors（1 case in the observation group and 1 case in the control group）,3 neonates with 1 high risk factor（1 case in the observation group and 2 cases in the control group）,14 neonates with 2 high risk factors（7 cases in the observation group and 7 cases in the control group）,and 13 neonates with 3 high risk factors（4 cases in the observation group and 9 cases in the control group）.There were 8 neonates with 4 high-risk factors（3 cases in the observation group and 5 cases in the control group）and 2 neonates with 5 high-risk factors（2 cases in the observation group）.Continuity correction X2 test showed no statistical significance（P>0.05）.4.There was no significant difference in mechanical ventilation time,oxygen time and average length of hospital stay between the two groups（P>0.05）.Subgroup analysis of premature infants and full-term infants showed no significant differences in mechanical ventilation time,oxygen use time and mean hospital stay between the two groups（P>0.05）.The correlation bar chart showed that the mechanical ventilation time of all neonates in the observation group was shorter than that of the control group,and the mechanical ventilation time of full-term infants was significantly shorter than that of the control group.The oxygen time of premature infants was significantly shorter than that of the control group,and the average length of hospital stay of premature infants was significantly shorter than that of the control group.5.Among the 42 neonates included in this study,30 had mechanical ventilation duration≥3 days（13 cases in the observation group and 17 cases in the control group）,and 12 had mechanical ventilation duration<3 days（5 cases in the observation group and 7 cases in the control group）.Continuity correction X²test was performed for them,and the difference was not statistically significant（P>0.05）.Two groups of neonates with NRDS（mechanical ventilation≥3 days）were given 19 periods of mechanical ventilation within 3 days,a total of 570 values of TcPCO₂,repeated measurement data analysis of variance and independent sample T test.The results showed as follows:there was no statistical significance in TcPCO₂at 0h at the beginning of mechanical ventilation between the two groups（mechanical ventilation≥3 days）（P>0.05）;The TcPCO₂of the observation group was lower than that of the control group at 11h,19h,27h,35h,43h,51h,59h and 67h（corresponding to the cumulative time of prone ventilation 6h,9h,12h,15h,18h,21h,24h and 27h,respectively）,and the difference was statistically significant（P<0.05）.There was no significant difference at other time points（P>0.05）.After multiple comparisons,the TcPCO₂at each time after mechanical ventilation in the observation group was improved compared with that before mechanical ventilation（0h）（P<0.05）,while the TcPCO₂at each time after mechanical ventilation in the control group was not significantly improved compared with that before mechanical ventilation（0h）（P>0.05）.The correlation broken line graph shows that the average value of TcPCO₂in the observation group has a large overall fluctuation range,which fluctuates obviously within the range of 35-50mm Hg,and presents a rapid rising or declining trend in successive periods.The average value of TcPCO₂in the control group changed steadily within the range of 40-50mm Hg,and showed a gradual and slow rising trend.6.Comparison of related complications between the two groups:2 cases of air-leakage syndrome（2 cases in the control group）,3 cases of VAP（3 cases in the control group）,7cases of tracheal intubation displacement or tube blockage（2 cases in the observation group and 5 cases in the control group）,4 cases of BPD（1 case in the observation group and 3cases in the control group）.Continuity correction X²test showed no significant difference in related complications between the two groups（P>0.05）.7.Predictive value of 3h TcPCO₂in prone position on whether the machine can be withdrawn after 3d in neonates with NRDS in the observation group:the AUC value corresponding to 3h TcPCO₂in the observation group was 0.597,indicating that the predictive value of 3h TcPCO₂on whether the machine can be withdrawn after 3d is relatively low.In the observation group of 12 premature infants,the AUC value corresponding to 3h TcPCO₂was less than 0.5,which was not consistent with the actual situation.In the observation group of 6 full-term infants,the AUC value corresponding to3h TcPCO₂was 1.000（95%CI:100.00%～100.00%）,indicating that 3h TcPCO₂had a very high predictive value for whether the machine could be removed after 3d.The Cut-off value of 3h TcPCO₂for predicting whether the machine can be removed after 3 days of term was40mm Hg,and the sensitivity and specificity were 100%.Conclusions1.Compared with conventional supine ventilation,prone position did not significantly shorten the length of mechanical ventilation,oxygen use and hospital stay of NRDS neonates.2.Compared with conventional supine ventilation,prone position is beneficial to improve the ventilation of NRDS neonates.3.Compared with conventional supine position,there was no significant difference in the incidence of air leakage syndrome,ventilator-associated pneumonia,tracheal catheter displacement or blockage,and bronchopulmonary dysplasia.4.The percutaneous partial pressure of carbon dioxide（TcPCO₂）for 3 hours in prone position is a good predictor of whether neonates with full-term NRDS can be withdrawn from the machine after 3 days.