Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA.
Division of Neonatology, Children's National Medical Center, George Washington University, Washington, DC, USA.
Lung. 2022 Feb;200(1):59-65. doi: 10.1007/s00408-021-00497-9. Epub 2022 Jan 11.
Tracheobronchomalacia (TBM) is common in neonates with bronchopulmonary dysplasia (BPD) and is associated with higher morbidity. This study evaluates the value of a CT protocol to assess the degree of TBM and gauge the adequacy of prescribed PEEP.
Four infants with severe BPD on invasive mechanical ventilation underwent a chest CT protocol, including limited reduced-dose expiratory scans with varying PEEP levels.
Baseline PEEP was adjusted in all subjects after performing the Dynamic PEEP CT. In two infants, the PEEP was increased due to significant TBM and in the other two without signs of TBM PEEP was decreased. The clinical course improved in all patients after adjusting PEEP.
A "Dynamic PEEP" study may be reliable and non-invasive imaging modality for the evaluation of adequate ventilator settings in infants with severe BPD who are not optimal candidates for bronchoscopy.
气管支气管软化症（TBM）在患有支气管肺发育不良（BPD）的新生儿中很常见，并且与更高的发病率相关。本研究评估了 CT 方案评估 TBM 程度和评估规定 PEEP 是否充分的价值。
4 名患有严重 BPD 的接受有创机械通气的婴儿进行了胸部 CT 方案，包括使用不同 PEEP 水平进行有限的低剂量呼气扫描。
在进行动态 PEEP CT 后，所有受试者的基础 PEEP 均进行了调整。在两名婴儿中，由于存在明显的 TBM 而增加了 PEEP，而在另外两名没有 TBM 迹象的婴儿中降低了 PEEP。调整 PEEP 后，所有患者的临床病程均得到改善。
“动态 PEEP”研究可能是一种可靠且非侵入性的成像方式，可用于评估不适合支气管镜检查的患有严重 BPD 的婴儿的呼吸机设置是否合适。
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