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


METHODS
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.


RESULTS
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.


CONCLUSIONS
LRM led to the earlier lowest FiO2 of the first 12 h of life and a shorter O2 dependency.
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
R
R
Wu
Anhui Medical University, Hefei, China.
S-B
SB
Li
Huaian First People's Hospital, Nanjing Medical University, Huaian, China.
Z-F
ZF
Tian
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
N
N
Li
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
G-F
GF
Zheng
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
Y-X
YX
Zhao
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
H-L
HL
Zhu
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
J-H
JH
Hu
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
L
L
Zha
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
M-Y
MY
Dai
Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China.
W-Y
WY
Xu
D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D059725:Interactive Ventilatory Support / Q000379:methods*; D008168:Lung / Q000503:physiopathology*; D008297:Male; D010100:Oxygen / Q000008:administration & dosage*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*
D011663:Pulmonary Surfactants; D010100:Oxygen