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 cmH2O 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 versus 29.4 +/- 0.9 weeks; body weight 1,314 +/- 96 versus 1,296 +/- 88 g; Silverman Anderson score for babies at start of ventilation 8.6 +/- 0.8 versus 8.2 +/- 0.7; initial FiO2 0.56 +/- 0.16 versus 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 versus 6.7 +/- 0.6 cmH2O, p = 0.00), time to lowest FiO2 (101 +/- 18 versus 342 +/- 128 min; p = 0.000) and O2 dependency (7.83 +/- 2.04 versus 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.
Reprinted by permission from Journal of Perinatology, Macmillan Publishers Ltd.

Full text (sometimes free) may be available at these link(s):      help

• DOI
• PubMed
• PDF locator
• publisher