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

Journal of Perinatology volume 34, pages 524–527 (2014)Cite this article

Subjects

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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Acknowledgements

We thank all the neonatal units and staff who responded to our survey. This research was funded by grants from Jiangsu Province Health Department (Project no: F201233).

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Author notes

  1. R Wu, S-B Li and Z-F Tian: These authors contributed equally to this work.

Authors and Affiliations

  1. Neonatal Medical Center, Huaian Maternity and Child Healthcare Hospital, Anhui Medical University, Huaian, China

    R Wu, N Li, G-F Zheng, Y-X Zhao, H-L Zhu, J-H Hu, L Zha, M-Y Dai & W-Y Xu

  2. Anhui Medical University, Hefei, China

    S-B Li

  3. Huaian First People's Hospital, Nanjing Medical University, Huaian, China

    Z-F Tian

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  1. R Wu
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Correspondence to R Wu.

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Wu, R., Li, SB., Tian, ZF. et al. Lung recruitment maneuver during proportional assist ventilation of preterm infants with acute respiratory distress syndrome. J Perinatol 34, 524–527 (2014). https://doi.org/10.1038/jp.2014.53

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