Individualized lung recruitment during high-frequency ventilation in preterm infants is not associated with lung hyperinflation and air leaks.

Anne P De Jaegere,Anton H Van Kaam,Rick R Van Rijn,Martin Offringa,Eline E Deurloo

doi:10.1007/s00431-016-2744-4

Abstract

Lung recruitment during high-frequency ventilation (HFV) in preterm infants with respiratory distress syndrome (RDS) has been associated with an increased risk of lung hyperinflation and air leaks. Individualizing the lung recruitment procedure to the severity of lung disease of each patient might reduce these risks. In this prospective cohort study, we evaluated chest X-ray (CXR) characteristics during individualized oxygenation-guided lung recruitment with HFV in preterm infants with RDS, before and after surfactant therapy. Two pediatric radiologists scored radiolucency, the presence of lung hyperinflation, and/or air leaks following lung recruitment during HFV in 69 infants before and 39 infants after surfactant treatment. Following lung recruitment, the median radiolucency score was 2, with 44 (64 %) infants having a score ≤2. Only mild to moderate hyperinflation was seen in 13 (19 %) infants, with no air leaks. After the surfactant, the radiolucency score improved in 62 % of 39 paired CXRs (p < 0.001). Mild to moderate hyperinflation was seen in nine (24 %) patients. During the entire admission, only four (6 %) of the patients developed air leaks.Conclusion: The risk of significant hyperinflation and air leaks is low when using an individualized oxygenation-guided recruitment procedure during HFV in preterm infants with RDS. What is Known: • Lung recruitment during high-frequency ventilation in preterm infants with respiratory distress syndrome is associated with an increased risk of lung hyperinflation and air leaks. What is New: • The risk of lung hyperinflation and air leaks is low when using an individualized oxygenation-guided lung recruitment procedure during high-frequency ventilation in preterm infants with respiratory distress syndrome.

Highlights

Respiratory distress syndrome (RDS) is one of the most common causes of respiratory failure in preterm infants
Lung recruitment during high-frequency ventilation in preterm infants with respiratory distress syndrome is associated with an increased risk of lung hyperinflation and air leaks
Between March 2004 and August 2005, a total of 103 consecutive patients were treated with open-lung High-frequency ventilation (HFV) and 69 of these infants were included in the study (Table 1)

Summary

Introduction

Respiratory distress syndrome (RDS) is one of the most common causes of respiratory failure in preterm infants. Despite the increasing use of primary nasal continuous positive airway pressure (nCPAP), many infants with RDS still need to be intubated, mechanically ventilated, and treated with exogenous surfactant to restore lung function and gas exchange [1]. High-frequency ventilation (HFV) is a frequently used lung-protective ventilation mode in preterm infants with RDS [18, 22]. Animal and human studies have shown that HFV is only lung protective if combined with a recruitment procedure designed to reverse atelectasis and stabilize lung volume at functional residual capacity, i.e., the optimal lung volume or open-lung ventilation strategy [5, 12]. There have been concerns that lung recruitment during HFV may increase the risk of lung hyperinflation and air leaks in infants with RDS [3, 4, 19]

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Discussion

Conclusion