Neonatal Intensive Care Unit, V. Buzzi Children's Hospital ICP, Via Castelvetro 32, Milan, Italy.
Am J Perinatol. 2011 Aug;28(7):521-8. doi: 10.1055/s-0031-1272970. Epub 2011 Mar 4.
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 H (2)O PEEP every 5 minutes, until fraction of inspired oxygen (Fi O(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 Fi O(2) rose, we reincremented PEEP until Sp O(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 Fi O(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 H (2)O, P=0.00), time to lowest Fi O(2) (94 ± 24 versus 435 ± 221 minutes; P=0.000) and O(2) 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 Fi O(2) of the first 12 hours of life and a shorter O (2) dependency.
早产儿需要实现足够的肺容量。高频振荡通气期间应用肺复张手法（LRM）。我们研究了在常规呼吸窘迫综合征（RDS）通气的婴儿中应用正呼气末压（PEEP）的 LRM 对氧合和结局的影响。接受表面活性剂治疗的辅助控制通气+容量保证的 RDS 早产儿随机接受 LRM（A 组）或不接受 LRM（B 组）。LRM 每 5 分钟递增 0.2 cm H 2 O PEEP，直到吸入氧分数（FiO 2 ）=0.25。然后降低 PEEP，并在压力/容积曲线的呼气支上设置肺容积。当外周氧饱和度下降和 FiO 2 升高时，我们再次增加 PEEP，直到 SpO 2 稳定。A 组（N=10）和 B 组（N=10）婴儿相似：胎龄 25±2 与 25±2 周；体重 747±233 与 737±219 g；婴儿临床风险指数 9.8 与 8.1；初始 FiO 2 分别为 56±24 与 52±21。LRM 开始于出生后 86±69 分钟，持续 61±18 分钟。A 组和 B 组在生命的前 12 小时内显示出不同的最大 PEEP（6.1±0.3 与 5.3±0.3 cm H 2 O，P=0.00）、最低 FiO 2 的时间（94±24 与 435±221 分钟；P=0.000）和 O 2 依赖（29±12 与 45±17 天；P=0.04）。未观察到不良事件和结局的差异。LRM 导致生命前 12 小时最低 FiO 2 的更早出现和 O 2 依赖的缩短。
