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Positive end expiratory pressure in acute and chronic respiratory distress
A Greenough1, V Chan, M F Hird
1Department of Child Health, King's College Hospital, London.
Insights
Positive end-expiratory pressure (PEEP) up to 6 cm H2O can benefit infants with respiratory distress, even after the first week of life. Further studies are needed to assess long-term clinical outcomes and potential circulatory effects.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Respiratory distress syndrome (RDS) and chronic respiratory issues are common in preterm infants.
- Optimizing mechanical ventilation, particularly positive end-expiratory pressure (PEEP), is crucial for managing these conditions.
Purpose of the Study:
- To determine the optimal level of PEEP in infants with acute RDS and chronic respiratory distress.
- To evaluate the effects of varying PEEP levels on gas exchange in these infant populations.
Main Methods:
- A sequential PEEP trial (3, 0, 3, 6, 3 cm H2O) was conducted in 16 infants with acute RDS and 16 with chronic respiratory distress.
- Ventilator parameters were constant, with 20-minute PEEP intervals followed by arterial blood gas analysis.
Main Results:
- In acute RDS, PEEP did not significantly alter oxygenation but reduced PaCO2 at 0 cm H2O and increased it at 6 cm H2O.
- In chronic respiratory distress, oxygenation decreased at 0 cm H2O PEEP and improved at 6 cm H2O PEEP, with no significant PaCO2 changes.
Conclusions:
- PEEP up to 6 cm H2O may be beneficial for infants beyond the first week of life.
- High PEEP levels may cause circulatory disturbances, necessitating controlled studies on longer-term clinical outcomes.
Abstract:
The optimum level of positive end expiratory pressure (PEEP) was determined in 16 infants with respiratory distress syndrome (median gestational age 29 weeks, median postnatal age 1 day) and in 16 infants with chronic respiratory distress (median gestational age 25 weeks, median postnatal age 15 days). All infants were studied at a PEEP sequence of 3, 0, 3, 6, and 3 cm H2O, all other ventilator parameters being kept constant. Each PEEP level was maintained for 20 minutes and at the end of each period arterial blood gas was checked. During acute respiratory distress syndrome there were no significant changes in oxygenation but arterial carbon dioxide tension (PaCO2) significantly decreased from a mean of 4.93 kPa at 3 cm H2O to 4.40 kPa at 0 cm H2O and increased to a mean of 5.87 kPa at 6 cm H2O. In the infants with chronic respiratory distress, oxygenation fell from a mean of 8.66 kPa at 3 cm H2O to 6.40 kPa at 0 cm H2O and improved at 6 cm H2O to a mean of 10.50 kPa. There were no significant changes in PaCO2. We conclude that addition of PEEP, up to 6 cm H2O, may be useful even after the first week of life. High levels of PEEP, however, have previously been reported, in certain infants, to result in circulatory disturbance. It is therefore important to assess the use of 6 cm H2O PEEP in a controlled study of longer term clinical outcome.