title: [Application of lung recruitment maneuver in preterm infants with respiratory distress syndrome ventilated by proportional assist ventilation].
abstract: OBJECTIVE
  To understand the effect of lung recruitment maneuver (LRM) with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in preterm infants with respiratory distress syndrome (RDS) ventilated by proportional assist ventilation (PAV).
  
  
  METHODS
  From January 2012 to June 2013, thirty neonates with a diagnosis of RDS who required mechanical ventilation were divided randomly into LRM group (n=15, received an LRM and surport by PAV) and control group (n=15, only surport by PAV). There were no statistically significant differences in female (7 vs. 6); gestational age [(29.3±1.2) vs. (29.5±1.1) weeks]; body weight[(1,319±97) vs. (1,295±85) g]; Silverman Anderson(SA) score for babies at start of ventilation (7.3±1.2 vs. 6.9±1.4); initial FiO2 (0.54±0.12 vs. 0.50±0.10) between the two groups (all P>0.05). LRM entailed increments of 0.2 cmH2O (1 cmH2O=0.098 kPa) PEEP every 5 minutes, 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. The related clinical indicators of the two group were observed.
  
  
  RESULTS
  The doses of surfactant administered (1.1±0.3 vs. 1.5±0.5, P=0.027), Lowest FiO2 (0.29±0.05 vs. 0.39±0.06, P=0.000), time to lowest FiO2[ (103±18) vs. (368±138) min, P=0.000] and O2 dependency [(7.6±1.0) vs.( 8.8±1.3) days, P=0.021] in LRM group were lower than that in control group (all P<0.05). The maximum PEEP during the first 12 hours of life [(8.4±0.8) vs. (6.8±0.8) cmH2O, P=0.000] in LRM group were higher than that in control group (P<0.05). FiO2 levels progressively decreased (F=35.681, P=0.000) and a/AO2 Gradually increased (F=37.654, P=0.000). No adverse events and no significant differences in the outcomes were observed.
  
  
  CONCLUSIONS
  LRM can reduce the doses of pulmonary surfactant administered, time of the respiratory support and the oxygen therapy in preterm children with RDS.
authors.affiliation: Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital Affiliated to Yangzhou University Medical Academy, Huaian 223002, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Wu
authors.forename: Na
authors.initials: N
authors.lastname: Li
authors.forename: Jinhui
authors.initials: J
authors.lastname: Hu
authors.forename: Li
authors.initials: L
authors.lastname: Zha
authors.forename: Hongli
authors.initials: H
authors.lastname: Zhu
authors.forename: Guofang
authors.initials: G
authors.lastname: Zheng
authors.forename: Yuxiang
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Neonatology, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command, Beijing 100700, China. Email:zhjfengzc@126.com.
authors.forename: Zhichun
authors.initials: Z
authors.lastname: Feng
mesh_terms: D005260:Female; 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; D010102:Oxygen Inhalation Therapy; D011175:Positive-Pressure Respiration / Q000379:methods*; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012119:Respiration; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume; D016896:Treatment Outcome
chemical_list: D011663:Pulmonary Surfactants; D010100:Oxygen