Early extubation to noninvasive respiratory support of former preterm lambs improves long-term respiratory outcomes

Mar Janna Dahl, Chiara Veneroni, Anna Lavizzari, Sydney Bowen, Haleigh Emerson, Andrew Rebentisch, Elaine Dawson, Kyle Summers, Luke Pettet, Zhengming Wang, Donald M. Null, Bradley A. Yoder, Raffaele L. Dellacà, Kurt H. Albertine

Research output: Contribution to journalArticlepeer-review

Abstract

Invasive mechanical ventilation (IMV) and exposure to oxygen-rich gas during early postnatal life are contributing factors for long-term pulmonary morbidities faced by survivors of preterm birth and bronchopulmonary dysplasia. The duration of IMV that leads to long-term pulmonary morbidities is unknown. We compared two durations of IMV (3 h vs. 6 days) during the first 6–7 days of postnatal life in preterm lambs to test the hypothesis that minimizing the duration of IMV will improve long-term respiratory system mechanics and structural outcomes later in life. Moderately preterm (~85% gestation) lambs were supported by IMV for either 3 h or 6 days before weaning from all respiratory support to become former preterm lambs. Respiratory system mechanics and airway reactivity were assessed monthly from 1 to 6 mo of chronological postnatal age by the forced oscillation technique. Quantitative morphological measurements were made for smooth muscle accumulation around terminal bronchioles and indices of alveolar formation. Minimizing IMV to 3 h led to significantly better (P < 0.05) baseline respiratory system mechanics and less reactivity to methacholine in the first 3 mo of chronological age (2 mo corrected age), significantly less (P < 0.05) accumulation of smooth muscle around peripheral resistance airways (terminal bronchioles), and significantly better (P < 0.05) alveolarization at the end of 5 mo corrected age compared with continuous IMV for 6 days. We conclude that limiting the duration of IMV following preterm birth of fetal lambs leads to better respiratory system mechanics and structural outcomes later in life.

Original languageEnglish (US)
Pages (from-to)248-262
Number of pages15
JournalAmerican Journal of Physiology - Lung Cellular and Molecular Physiology
Volume321
Issue number1
DOIs
StatePublished - Jul 2021

Keywords

  • Alveolar formation
  • Bronchopulmonary dysplasia
  • Mechanical ventilation
  • Neonatal chronic lung disease
  • Pulmonary function

ASJC Scopus subject areas

  • Physiology
  • Pulmonary and Respiratory Medicine
  • Physiology (medical)
  • Cell Biology

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