[Lung injury and ventilatory strategies]

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Critical Care

Background:

• Premature lungs are vulnerable to injury from mechanical ventilation and high oxygen.
• Atelectrauma and volutrauma from inadequate tidal volume (Vt) are key concerns in ventilating preterm infants with respiratory distress syndrome (RDS).

Purpose of the Study:

• To evaluate the efficacy and safety of targeted volume ventilation with Volume Guarantee (VG) in preterm infants with severe RDS.
• To compare different VG settings (Vt = 3 or 5 ml/Kg) against conventional mechanical ventilation.

Main Methods:

• Randomized clinical trials were conducted in preterm infants (25-32 weeks gestational age) with severe RDS.
• Infants received mechanical ventilation either without VG or with VG set at 3 ml/Kg or 5 ml/Kg.
• Measurements included mean airway pressure (PAW), peak inspiratory pressure (PIP), and cytokine levels (IL-6, IL-8, TNF-α) in tracheal aspirates.

Main Results:

• Synchronized ventilation with VG at 5 ml/Kg significantly reduced mean airway pressure (PAW), peak inspiratory pressure (PIP) (p < 0.05).
• A significant reduction in cytokine production (IL-6, IL-8, TNF-α) was observed in tracheal aspirates with VG at 5 ml/Kg.
• No significant reduction in chronic lung disease (CLD) was observed in the VG 5 ml/Kg group.

Conclusions:

• Targeted volume ventilation with VG set at 5 ml/Kg demonstrates a protective role against lung injury and inflammation in preterm infants with RDS.
• This strategy minimizes volutrauma and reduces the inflammatory lung response.
• The multifactorial nature of CLD may explain the lack of significant reduction in this study.