Lung Recruitment Maneuver during Volume Guarantee Ventilation of Preterm Infants with Acute Respiratory Distress Syndrome

ABSTRACT

Preterm infants need the achievement of adequate lung volume. Lung recruitment maneuver (LRM) is applied during high-frequency oscillatory ventilation. We investigated the effect of an LRM with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in infants conventionally ventilated for respiratory distress syndrome (RDS). Preterm infants in assisted controlled ventilation + volume guarantee for RDS after surfactant randomly received an LRM (group A) or did not (group B). LRM entailed increments of 0.2 cm H₂O PEEP every 5 minutes, 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. Group A (n = 10) and group B (n = 10) infants were similar: gestational age 25 ± 2 versus 25 ± 2 weeks; body weight 747 ± 233 versus 737 ± 219 g; clinical risk index for babies 9.8 versus 8.1; initial Fio ₂ 56 ± 24 versus 52 ± 21, respectively. LRM began at 86 ± 69 minutes of age and lasted for 61 ± 18 minutes. Groups A and B showed different max PEEP during the first 12 hours of life (6.1 ± 0.3 versus 5.3 ± 0.3 cm H₂O, p = 0.00), time to lowest Fio ₂ (94 ± 24 versus 435 ± 221 minutes; p = 0.000) and O₂ dependency (29 ± 12 versus 45 ± 17 days; p = 0.04). No adverse events and no differences in the outcomes were observed. LRM led to the earlier lowest Fio ₂ of the first 12 hours of life and a shorter O₂ dependency.

KEYWORDS

Volume guarantee ventilation - open lung concept - lung recruitment maneuver - preterm infants - RDS

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