Regular Lung Recruitment Maneuvers during High-Frequency Oscillatory Ventilation in Extremely Preterm Infants: A Randomized Controlled Trial

Abstract

Background Lung recruitment maneuvers (LRMs) improve lung volume at initiation of high-frequency oscillatory ventilation (HFOV), but it is unclear when to repeat LRMs. We evaluated the efficiency of scheduled LRMs. Methods In a randomized controlled trial, extremely preterm infants on HFOV received either LRMs at 12-hour intervals and when clinically indicated (intervention) or only when clinically indicated (control). The primary outcome was the cumulative oxygen saturation index (OSI) over HFOV time, limited to 7 days. Additionally, LRMs were analyzed with respect to OSI improvement. Results Fifteen infants were included in each group. The median (range) postmenstrual age and weight at HFOV start were 24+2 (23+0, 27+6) weeks and 615 (435, 920) g. The mean (SD) cumulative OSI was 4.95 (1.72) in the intervention versus 5.30 (2.08) in the control group (p=0.61). The mean (SD) number of LRMs in 12 hours was 1.3 (0.2) in the intervention versus 1.1 (0.5) in the control group (p=0.13). Performing LRM when FiO2>0.6 resulted in a mean OSI reduction of 3.6. Conclusion Regular versus clinically indicated LRMs were performed with equal frequency in preterm infants during HFOV, and consequently, no difference in lung volume was observed. LRMs seem to be most efficient at high FiO2. Trial registration ClinicalTrials.gov ID: NCT04289324 (28/02/2020).