Dynamic positive end-expiratory pressure strategies using time and pressure recruitment at birth reduce early expression of lung injury in preterm lambs.

Autor: Tingay DG; Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia.; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.; Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia., Pereira-Fantini PM; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia., Miedema M; Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia.; Neonatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., McCall KE; Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia.; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia., Perkins EJ; Neonatology, The Royal Children's Hospital, Parkville, Victoria, Australia.; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia., Dowse G; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia., Schinckel N; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia., Sourial M; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia., Davis PG; Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.; Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia.; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: American journal of physiology. Lung cellular and molecular physiology [Am J Physiol Lung Cell Mol Physiol] 2022 Oct 01; Vol. 323 (4), pp. L464-L472. Date of Electronic Publication: 2022 Aug 23.
DOI: 10.1152/ajplung.00047.2022
Abstrakt: Positive end-expiratory pressure (PEEP) is critical to the preterm lung at birth, but the optimal PEEP level remains uncertain. The objective of this study was to determine the effect of maximum PEEP levels at birth on the physiological and injury response in preterm lambs. Steroid-exposed preterm lambs (124-127 days gestation; n = 65) were randomly assigned from birth to either 1 ) positive pressure ventilation (PPV) at 8 cmH 2 O PEEP or 3-min dynamic stepwise PEEP strategy (DynPEEP), with either 2 ) 20 cmH 2 O maximum PEEP (10 PEEP second steps) or 3 ) 14 cmH 2 O maximum PEEP (20-s steps), all followed by standardized PPV for 90 min. Lung mechanics, gas exchange, regional ventilation and aeration (electrical impedance tomography), and histological and molecular measures of lung injury were compared between groups. Dynamic compliance was greatest using a maximum 20 cmH 2 O (DynPEEP). There were no differences in gas exchange, end-expiratory volume, and ventilator requirements. Regional ventilation became more uniform with time following all PEEP strategies. For all groups, gene expression of markers of early lung injury was greater in the gravity nondependent lung, and inversely related to the magnitude of PEEP, being lowest in the 20 cmH 2 O DynPEEP group overall. PEEP levels had no impact on lung injury in the dependent lung. Transient high maximum PEEP levels using dynamic PEEP strategies may confer more lung protection at birth.
Databáze: MEDLINE
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