Published ahead of print on June 8, 2006, doi:10.1164/rccm.200603-351OC Am. J. Respir. Crit. Care Med., Volume 174, Number 6, September 2006, 639-645 A more recent version of this article appeared on September 15, 2006
Submitted on March 10, 2006 Lung Recruitment Using Oxygenation During Open Lung High-Frequency Ventilation in Preterm InfantsAnne De Jaegere1,1 Department of Neonatology, Emma Children's Hospital AMC, University of of Amsterdam, Amsterdam, The Netherlands * To whom correspondence should be addressed. E-mail: a.h.vankaam{at}amc.uva.nl.
Rationale: Changes in oxygenation are often used to guide the recruitment procedure during open lung high-frequency ventilation in preterm infants. However, data on the feasibility and safety of this approach in daily clinical practice are limited. Objective: To prospectively collect data on ventilator settings, gas exchange and circulatory
parameters before and after surfactant therapy during open lung high-frequency ventilation. Methods: In 103 preterm infants with respiratory distress syndrome the opening, closing and optimal pressure was determined during high-frequency ventilation by stepwise increasing and decreasing the continuous distending pressure, defining optimal recruitment as adequate oxygenation using a fraction of inspired oxygen Key words: respiratory distress syndrome, air leaks, surfactant, chronic lung disease
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0.25. This procedure was repeated after each surfactant treatment. Measurements and main results: The mean presurfactant opening and optimal continuous distending pressure were respectively, 20.5 ± 4.3 and 14.0 ± 4.0 cmH2O, with a fraction of inspired oxygen of 0.24 ± 0.04. Surfactant treatment enabled a reduction in the mean optimal pressure of almost 6 cmH2O without compromising oxygenation. Blood pressure and heart rate remained stable and no air leaks were observed during the recruitment procedures. The mortality rate, the incidence of severe intracranial hemorrhage or periventricular leukomalacia and chronic lung disease at 36 wk was comparable to previously reported data.
Conclusion: 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.
