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Effect of positive end expiratory pressure on functional residual capacity and compliance in surfactant-treated

J Dinger1, A Töpfer, P Schaller

  • 1Clinic of Pediatrics, Medical Faculty, Technical University of Dresden, Germany.

Journal of Perinatal Medicine
|May 10, 2001
PubMed

Insights

Lowering positive end expiratory pressure (PEEP) from 0.4 to 0.2 kPa improved lung compliance and reduced carbon dioxide in most preterm infants. These findings suggest lower PEEP levels may be beneficial after surfactant treatment.

Area of Science:

  • Neonatal Medicine
  • Respiratory Physiology
  • Pediatric Critical Care

Background:

  • Positive end expiratory pressure (PEEP) is a standard ventilation strategy for preterm infants.
  • Surfactant treatment and PEEP both increase lung volume.
  • Optimal PEEP levels require careful consideration to balance lung volume, compliance, and gas exchange.

Purpose of the Study:

  • To investigate the impact of varying PEEP levels (0.2 to 0.4 kPa) on lung volume, respiratory system compliance, and arterial blood gases in preterm infants.
  • To determine the optimal PEEP setting for preterm infants 72 hours post-surfactant treatment.

Main Methods:

  • Functional residual capacity (FRC), respiratory system compliance, and arterial blood gases were measured in 20 preterm infants.
  • Infants received surfactant treatment, and PEEP levels were adjusted to 0.2, 0.3, and 0.4 kPa in random order.
  • Measurements were taken after maintaining each PEEP level for 20 minutes, with FRC assessed via SF6 washout.

Main Results:

  • Increasing PEEP from 0.2 to 0.4 kPa led to increased FRC and oxygenation in all infants.
  • In 16 infants, higher PEEP levels decreased compliance and increased paCO2.
  • Conversely, 4 infants showed improved compliance and reduced CO2 with elevated PEEP.

Conclusions:

  • Reducing PEEP from 0.4 to 0.2 kPa improved compliance and reduced paCO2 in the majority of infants.
  • Lower PEEP levels (< 0.3 kPa) may be appropriate for preterm infants 72 hours after surfactant replacement.
  • These findings highlight the clinical importance of individualized PEEP testing.
Abstract

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