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

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 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 FiO2 (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). 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. © 2014 Nature America, Inc.