Abstract
RDS is characterized by an inadequate surfactant system which, in the untreated course, leads to progressive atelectasis and decreased FRC. PEEP is used to counter atelectasis and reduce intrapulmonary shunting. FRC is controlled by PEEP yet PEEP is selected primarily on the basis of blood gases and not FRC. We were concerned that these empirical methods of selecting PEEP for RDS infants frequently result in FRC levels well above or below normal. Therefore, we measured the FRC of 14 prematurely born infants in their second day of life. The infants' mean (± SD) gestational age was 31.5 ± 2.2 wk; birth wt 1.6 ± 0.5 kg; Apgar score (1 min) 4.4 ± 2.2. All infants had clinically diagnosed RDS and were ventilated with the following mean settings: peak inspiratory pressure 23.3 (range 14-34) cm H2O; PEEP 4.4 (3-8) cm H2O; rate 42 (20-60) BPM. Computerized N2 washout methods, similar to those used in this study, show the FRC of healthy infants this postnatal age to be 17 ± 2 ml/kg body wt (Hansen et al, Ped 1970). In our study on RDS infants the FRC ranged from 3 to 33 ml/kg with a mean of 14.5 ml/kg. Only 3 infants (21%) had volumes within one SD of normal. In 5 infants, FRC was greater than one SD above normal and in 6 infants, FRC was greater than one SD below normal. Six infants (43%) had FRC values outside of 2 SD of normal. These results suggest that conventional methods of selecting PEEP do not result in the maintenance of normal FRC levels in infants with RDS.
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Richardson, P., Carlstrom, J. THE FUNCTIONAL RESIDUAL CAPACITY (FRC) OF INFANTS WITH RESPIRATORY DISTRESS SYNDROME (RDS) RECEIVING POSITIVE END-EXPIRATORY PRESSURES (PEEP). Pediatr Res 18 (Suppl 4), 343 (1984). https://doi.org/10.1203/00006450-198404001-01498
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DOI: https://doi.org/10.1203/00006450-198404001-01498
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