Lung recruitment maneuver during proportional assist ventilation of preterm infants with acute respiratory distress syndrome

Objective:to investigate the effect of lung recruitment maneuver (lrm) with positive end-expiratory pressure (peep) on oxygenation and outcomes in preterm infants ventilated by proportional assist ventilation (pav) for respiratory distress syndrome (rds).study design:preterm infants on pav for rds after surfactant randomly received an lrm (group a, n=12) or did not (group b, n=12). lrm entailed increments of 0.2 cm h2o peep every 5 min, until fraction of inspired oxygen (fio2)=0.25. then peep was reduced and the lung volume was set on the deflation limb of the pressure/volume curve. when saturation of peripheral oxygen fell and fio2 rose, we reincremented peep until spo2 became stable.result:group a and b infants were similar: gestational age 29.5±1.0 vs 29.4±0.9 weeks; body weight 1314±96 vs 1296±88 g; silverman anderson score for babies at start of ventilation 8.6±0.8 vs 8.2±0.7; initial fio2 0.56±0.16 vs 0.51±0.14, respectively. the less doses of surfactant administered in group a than that in group b (p<0.05). groups a and b showed different max peep during the first 12 h of life (8.4±0.5 vs 6.7±0.6 cm h2o, p=0.00), time to lowest fio2 (101±18 versus 342±128 min; p=0.000) and o2 dependency (7.83±2.04 vs 9.92±2.78 days; p=0.04). fio2 levels progressively decreased (f=43.240, p=0.000) and a/ao2 ratio gradually increased (f=30.594, p=0.000). no adverse events and no differences in the outcomes were observed.conclusion:lrm led to the earlier lowest fio2 of the first 12 h of life and a shorter o2 dependency.