Feasibility of lung ultrasound-guided positive end-expiratory pressure adjustment in newborns

To evaluate whether an ultrasound-guided lung recruitment manoeuvre (LRM) can identify a positive end-expiratory pressure (PEEP) associated with improved aeration compared with clinically set PEEP during non-invasive respiratory support.

Feasibility study of 11 spontaneously breathing infants on continuous positive airway pressure or non-invasive ventilation. PEEP was increased stepwise by 2 cmH₂O from 4 to 10 cmH₂O. The PEEP with the lowest lung ultrasound score was recorded along with vital parameters.

In 10 of 11 infants (91%; 95% confidence interval 62-99, p = 0.01), the LRM identified a PEEP with a lower lung ultrasound score than the clinically set level; five infants required a higher and five a lower PEEP. Clinical parameters were stable or improved.

In this pilot cohort, lung ultrasound-guided PEEP adjustment appeared feasible and was associated with favourable short-term changes in lung aeration. Larger studies are required to validate these preliminary findings and determine clinical utility.