Lung recruitment in neonatal high-frequency oscillatory ventilation with volume-guarantee.

Autor: Solis-Garcia G; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain.; The Hospital for Sick Children, Toronto, Canada., González-Pacheco N; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Ramos-Navarro C; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Vigil-Vázquez S; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Gutiérrez-Vélez A; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Merino-Hernández A; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Rodríguez Sánchez De la Blanca A; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain., Sánchez-Luna M; Neonatology Division, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; Universidad Complutense de Madrid, Madrid, Spain.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2022 Dec; Vol. 57 (12), pp. 3000-3008. Date of Electronic Publication: 2022 Sep 06.
DOI: 10.1002/ppul.26124
Abstrakt: Background and Objectives: The optimal lung volume strategy during high-frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV-VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV-VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure.
Design and Methods: The prospective observational study was done in a tertiary-level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV-VG in preterm infants with severe respiratory failure.
Results: Twenty-seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23-25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H 2 O (IQR: 10-13), median critical lung opening mPaw during recruitment was 14 cm H 2 O (IRQ: 12-16), and median optimal mPaw was 12 cm H 2 O (IQR: 10-14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO 2 : 65.0 vs. 45.0, p < 0.01, SpO2/FiO 2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01).
Conclusion: In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV-VG.
(© 2022 Wiley Periodicals LLC.)
Databáze: MEDLINE
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