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

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Abstract

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 H2O PEEP every 5 min, until fraction of inspired oxygen (FiO2) = 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 FiO2 rose, we reincremented PEEP until SpO2 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 FiO2 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 H2O, P = 0.00), time to lowest FiO2 (101 ± 18 versus 342 ± 128 min; P = 0.000) and O2 dependency (7.83 ± 2.04 vs 9.92 ± 2.78 days; P = 0.04). FiO2 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 FiO2 of the first 12 h of life and a shorter O2 dependency.

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