Lung recruitment maneuver during proportional assist ventilation of preterm infants with acute respiratory distress syndrome

• Published in: Journal of perinatology Vol. 34; no. 7; pp. 524 - 527
• Main Authors: Wu, R, Li, S-B, Tian, Z-F, Li, N, Zheng, G-F, Zhao, Y-X, Zhu, H-L, Hu, J-H, Zha, L, Dai, M-Y, Xu, W-Y
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.07.2014; Nature Publishing Group
• Subjects: 692/308/409; Body weight; Care and treatment; Female; Gestational Age; Health aspects; Humans; Infant, Newborn; Infant, Premature; Infants; Infants (Premature); Interactive Ventilatory Support - methods; Intubation; Lung - physiopathology; Lungs; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Neonates; Newborn babies; original-article; Oxygen; Oxygen - administration & dosage; Oxygenation; Pediatric research; Pediatric Surgery; Pediatrics; Positive-Pressure Respiration - methods; Premature babies; Pulmonary Gas Exchange; Pulmonary Surfactants - administration & dosage; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - physiopathology; Respiratory Distress Syndrome, Newborn - therapy; Surfactants; Ventilation; Ventilators; China
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2014.53

Objective: To investigate the effect of lung recruitment maneuver (LRM) with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in preterm infants ventilated by proportional assist ventilation (PAV) for respiratory distress syndrome (RDS). Study Design: Preterm infants on PAV for RDS after surfactant randomly received an LRM (group A, n =12) or did not (group B, n =12). LRM entailed increments of 0.2 cm H 2 O PEEP every 5 min, until fraction of inspired oxygen (FiO 2 )=0.25. Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve. When saturation of peripheral oxygen fell and FiO 2 rose, we reincremented PEEP until SpO 2 became stable. Result: Group A and B infants were similar: gestational age 29.5±1.0 vs 29.4±0.9 weeks; body weight 1314±96 vs 1296±88 g; Silverman Anderson score for babies at start of ventilation 8.6±0.8 vs 8.2±0.7; initial FiO 2 0.56±0.16 vs 0.51±0.14, respectively. The less doses of surfactant administered in group A than that in group B ( P <0.05). Groups A and B showed different max PEEP during the first 12 h of life (8.4±0.5 vs 6.7±0.6 cm H 2 O, P =0.00), time to lowest FiO 2 (101±18 versus 342±128 min; P =0.000) and O 2 dependency (7.83±2.04 vs 9.92±2.78 days; P =0.04). FiO 2 levels progressively decreased ( F =43.240, P =0.000) and a/ AO2 ratio gradually increased ( F =30.594, P =0.000). No adverse events and no differences in the outcomes were observed. Conclusion: LRM led to the earlier lowest FiO 2 of the first 12 h of life and a shorter O 2 dependency.