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Am J Perinatol 2011; 28(7): 521-528
DOI: 10.1055/s-0031-1272970
© Thieme Medical Publishers

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

Francesca Castoldi1 , Irene Daniele1 , Paola Fontana1 , Francesco Cavigioli1 , Enrica Lupo1 , Gianluca Lista1
  • 1Neonatal Intensive Care Unit, V. Buzzi Children's Hospital ICP, Milan, Italy
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Publication History

Publication Date:
04 March 2011 (online)

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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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Gianluca ListaM.D. 

Neonatal Intensive Care Unit, V. Buzzi Children's Hospital

ICP, Via Castelvetro 32, Milan 20153, Italy

Email: gianluca.lista@icp.mi.it

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