Lung Recruitment Using Oxygenation during Open Lung High-Frequency Ventilation in Preterm Infants

Jaegere, Anne De; Veenendaal, Mariëtte B. van; Michiels, Agnes; Kaam, Anton H. van

doi:10.1164/rccm.200603-351oc

Cited by 149 publications

(141 citation statements)

References 27 publications

Supporting

Mentioning

136

Contrasting

Order By: Relevance

“…In the already aerated lung, these are often called open lung strategies (14), and aim to exploit hysteresis to map the quasistatic pressure-volume relationship of the lung and apply ventilation on the deflation limb at an optimal applied pressure (13,14). Reassuringly, our findings that oxygenation, lung volume, and lung mechanics are improved with this approach, are consistent with previous animal (23,24) and human (13,16,17) studies in aerated diseased lungs. It is on the deflation limb that the most homogenous regional aeration occurs (13,15) and can be maintained with a lower PEEP than needed to recruit the lung (24,25).…”

Section: Articlessupporting

confidence: 87%

“…Such strategies generally use oxygenation to define the optimal applied pressure (13,14,16,17), an unreliable parameter at birth (18). Recently, indicators of lung mechanics have been shown to reliably define the point of maximum curvature and optimal pressure in human infants (19), with resultant improvement in compliance, carbon dioxide removal, and oxygenation.…”

mentioning

confidence: 99%

“…Alternatives to SI have not been examined during resuscitation of the newly born premature lung. The existing literature suggests that a stepwise PEEP strategy to aid aeration at birth and achieve lung recruitment may also overcome some of the practical issues of applying an optimal SI (15,16,19).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

et al. 2013

View full text Add to dashboard Cite

Background: Sustained inflation (SI) at birth facilitates establishment of functional residual capacity (FRC) in the preterm lung, but the ideal lung recruitment strategy is unclear. We have compared the effect of SI and a stepwise positive endexpiratory pressure (PEEP; SEP) strategy in a preterm model. Methods: 127 d gestation lambs received either 20-s SI (n = 9) or 2 cmH 2 O stepwise PEEP increases to 20 cmH 2 O every 10 inflations, and then decreases to 6 cmH 2 O (n = 10). Ventilation continued for 70 min, with surfactant administered at 10 min. Alveolar-arterial oxygen gradient (AaDO 2 ), compliance (C dyn ), end-expiratory thoracic volume (EEV RIP ; respiratory inductive plethysmography), and EEV and C dyn in the gravitydependent and nondependent hemithoraces (electrical impedance tomography) were measured throughout. Early mRNA markers of lung injury were analyzed using quantitative real-time PCR. results: From 15 min of life, AaDO2 was lower in SEP group (P < 0.005; two-way ANOVA). SEP resulted in higher and more homogeneous C dyn (P < 0.0001). Mean (SD) EEV RIP at 5 min was 18 (9) ml/kg and 6 (5) ml/kg following SEP and SI, respectively (P = 0.021; Bonferroni posttest); this difference was due to a greater nondependent hemithorax EEV. There was no difference in markers of lung injury. conclusion: An SEP at birth improved gas exchange, lung mechanics, and EEV, without increasing lung injury, compared to the SI strategy used.

show abstract

Section: Articlessupporting

confidence: 87%

mentioning

confidence: 99%

See 1 more Smart Citation

Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

et al. 2013

View full text Add to dashboard Cite

show abstract

“…The pressure, amplitude, and frequency were kept constant during the recruitment procedure. 15 If an infant received surfactant, the closing CDP, opening CDP, and optimal CDP were once more determined by the procedure described above, but with a minimum time interval of 5 min between the pressure steps. The procedure started with decremental pressure steps, unless the F IO 2 increased to Ͼ 0.25 after surfactant treatment, in which case CDP was increased in search of the new opening CDP.…”

Section: Ventilation Strategiesmentioning

confidence: 99%

“…15 During lung volume recruitment for HFOV, the expired tidal volume (V T ), gas transport coefficient (D CO 2 ), pressure amplitude (⌬P), and mean airway pressure were measured dynamically with the high-frequency ventilator. D CO 2 is analogous to minute ventilation during conventional mechanical ventilation.…”

Section: Ventilation Strategiesmentioning

confidence: 99%

High-Frequency Oscillatory Ventilation Versus Synchronized Intermittent Mandatory Ventilation Plus Pressure Support in Preterm Infants With Severe Respiratory Distress Syndrome

et al. 2013

View full text Add to dashboard Cite

BACKGROUND: Mechanical ventilation and surfactants are the standard treatment of preterm respiratory distress syndrome (RDS). The effects of the primary ventilation model on bronchopulmonary dysplasia (BPD) and long-term neurodevelopment outcomes are controversial. The purpose of this study was to compare the efficacy and safety of high-frequency oscillatory ventilation (HFOV) and synchronized intermittent mandatory ventilation plus pressure support ventilation (SIMV-PSV) in preterm infants with severe RDS. METHODS: A total of 366 eligible preterm infants were randomly assigned to treatment with HFOV (n ‫؍‬ 184) or SIMV-PSV (n ‫؍‬ 182). Surfactant was applied if P aO 2 /F IO 2 was < 200 mm Hg after 2 hours of ventilation. Primary outcomes were mortality or incidence of BPD. Secondary outcomes were duration of ventilation and hospitalization, surfactant requirements, pneumothorax, retinopathy of prematurity > stage 2, and neurodevelopment at 18 months of corrected age. RESULTS: Survival and complete outcome data were available for 288 infants at 18 months of corrected age. The incidence of death or BPD was significantly higher in the SIMV-PSV group (P ‫؍‬ .001). The duration of mechanical ventilation and hospitalization was shorter and the incidence of surfactant requirement and retinopathy of prematurity was lower in the HFOV group (P < .001, P ‫؍‬ .002, P ‫؍‬ .04, respectively). Moderate or severe neurological disability was less frequent in the HFOV group than in the SIMV-PSV group at 18 months (P ‫؍‬ .

show abstract

Noninvasive High-Frequency Oscillatory Ventilation vs Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation as Postextubation Support for Preterm Neonates in China

Zhu

Feng

et al. 2022

JAMA Pediatr

View full text Add to dashboard Cite

for the Nasal Oscillation Post-Extubation (NASONE) Study Group IMPORTANCE Several respiratory support techniques are available to minimize the use of invasive mechanical ventilation (IMV) in preterm neonates. It is unknown whether noninvasive high-frequency oscillatory ventilation (NHFOV) is more efficacious than nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) in preterm neonates after their first extubation.OBJECTIVE To test the hypothesis that NHFOV is more efficacious than NCPAP or NIPPV in reducing IMV after extubation and until neonatal intensive care unit discharge among preterm neonates. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, pathophysiology-based, assessor-blinded, 3-group, randomized clinical trial was conducted in 69 tertiary referral neonatal intensive care units in China, recruiting participants from December 1, 2017, to May 31, 2021. Preterm neonates who were between the gestational age of 25 weeks plus 0 days and 32 weeks plus 6 days and were ready to be extubated were randomized to receive NCPAP, NIPPV or NHFOV. Data were analyzed on an intention-to-treat basis. INTERVENTIONSThe NCPAP, NIPPV, or NHFOV treatment was initiated after the first extubation and lasted until discharge.MAIN OUTCOMES AND MEASURES Primary outcomes were total duration of IMV, need for reintubation, and ventilator-free days. These outcomes were chosen to describe the effect of noninvasive ventilation strategy on the general need for IMV.RESULTS A total of 1440 neonates (mean [SD] age at birth, 29.4 [1.8] weeks; 860 boys [59.7%]) were included in the trial. Duration of IMV was longer in NIPPV (mean difference, 1.2; 95% CI, 0.01-2.3 days; P = .04) and NCPAP (mean difference, 1.5 days; 95% CI, 0.3-2.7 days; P = .01) compared with NHFOV. Neonates who were treated with NCPAP needed reintubations more often than those who were treated with NIPPV (risk difference: 8.1%; 95% CI, 2.9%-13.3%; P = .003) and NHFOV (risk difference, 12.5%; 95% CI, 7.5%-17.4%; P < .001). There were fewer ventilator-free days in neonates treated with NCPAP than in those treated with NIPPV (median [25th-75th percentile] difference, −3 [−6 to −1] days; P = .01). There were no differences between secondary efficacy or safety outcomes, except for the use of postnatal corticosteroids (lower in NHFOV than in NCPAP group; risk difference, 7.3%; 95% CI, 2.6%-12%; P = .002), weekly weight gain (higher in NHFOV than in NCPAP group; mean difference, −0.9 g/d; 95% CI, −1.8 to 0 g/d; P = .04), and duration of study intervention (shorter in NHFOV than in NIPPV group; median [25th-75th percentile] difference, −1 [−3 to 0] days; P = .01).CONCLUSIONS AND RELEVANCE Results of this trial indicated that NHFOV, if used after extubation and until discharge, slightly reduced the duration of IMV in preterm neonates, and both NHFOV and NIPPV resulted in a lower risk of reintubation than NCPAP. All 3 respiratory support techniques were equally safe for this patient population.

show abstract

Lung Recruitment Using Oxygenation during Open Lung High-Frequency Ventilation in Preterm Infants

Abstract: Open lung high-frequency ventilation using oxygenation to guide the recruitment process is feasible and safe in preterm infants and enables a reduction of the fraction of inspired oxygen below 0.25 in the majority of preterm infants with respiratory distress syndrome.

Cited by 149 publications

References 27 publications

Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

High-Frequency Oscillatory Ventilation Versus Synchronized Intermittent Mandatory Ventilation Plus Pressure Support in Preterm Infants With Severe Respiratory Distress Syndrome

Noninvasive High-Frequency Oscillatory Ventilation vs Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation as Postextubation Support for Preterm Neonates in China

Contact Info

Product

Resources

About