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Changes in lung volume and ventilation following transition from invasive to noninvasive respiratory support and

Pauline S van der Burg1, Martijn Miedema1, Frans H de Jongh1

  • 1Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.

Pediatric Research
|December 18, 2014
PubMed

Insights

Extubating preterm infants and placing them in the prone position helps maintain end-expiratory lung volume (EELV) and increase tidal volume (VT). Prone positioning further improves EELV and shifts ventilation to the ventral lung regions, suggesting its benefit after extubation.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Respiratory Physiology

Background:

  • Minimizing lung injury in ventilated preterm infants involves early extubation.
  • Prone positioning is often used to enhance extubation success.
  • The impact of extubation and prone positioning on lung volumes in preterm infants was previously unknown.

Purpose of the Study:

  • To investigate the effects of transitioning from endotracheal to nasal continuous positive airway pressure (CPAP) on lung volumes.
  • To determine the impact of subsequent prone positioning on lung volumes and ventilation distribution.
  • To assess changes in end-expiratory lung volume (EELV) and tidal volume (VT) post-extubation and with prone positioning.

Main Methods:

  • Electrical impedance tomography (EIT) was used to monitor EELV, VT, and ventilation distribution during the transition to nasal CPAP and after prone positioning.
  • Continuous distending pressure (CDP) and fraction of inspired oxygen (FiO₂) were recorded.
  • The study included 20 preterm infants with a gestational age of 28.7 ± 1.7 weeks.

Main Results:

  • Following extubation, CDP decreased, while EELV and VT significantly increased without altering ventilation distribution.
  • Prone positioning led to a further increase in EELV and a decrease in respiratory rate.
  • Tidal volume distribution shifted towards ventral lung regions with prone positioning.

Conclusions:

  • Preterm infants can maintain EELV and increase VT when transitioned to noninvasive respiratory support.
  • Prone positioning enhances EELV and promotes ventral lung ventilation.
  • Prone positioning is recommended for preterm infants after extubation to optimize lung function.
Abstract

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