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Role of positive end-expiratory pressure changes on functional residual capacity in surfactant treated preterm
W J da Silva1, S Abbasi, G Pereira
1Neonatal Pulmonary Research Laboratory, Pennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia 19107.
Insights
Positive end-expiratory pressure (PEEP) significantly increases lung volume in infants receiving surfactant therapy for respiratory distress syndrome (RDS). Careful weaning from PEEP is recommended during mechanical ventilation to manage this synergistic effect.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Respiratory distress syndrome (RDS) is a common condition in preterm infants.
- Surfactant replacement therapy and positive end-expiratory pressure (PEEP) are standard treatments for RDS.
- Both interventions aim to improve lung volume and gas exchange.
Purpose of the Study:
- To investigate the effect of varying levels of PEEP on functional residual capacity (FRC) in preterm infants post-surfactant therapy.
- To assess the pulmonary mechanics and lung volume changes in neonates with RDS under different PEEP settings.
Main Methods:
- Pulmonary mechanics and FRC were measured in 21 preterm infants with RDS.
- Infants were studied > 48 hours post-surfactant therapy.
- PEEP levels were incrementally increased from 2 to 5 cmH2O.
Main Results:
- A significant, non-linear increase in mean FRC was observed as PEEP increased.
- FRC values rose from 18.4 mL/kg at 2 cmH2O PEEP to 26.2 mL/kg at 5 cmH2O PEEP (P < 0.01).
- These findings highlight the synergistic effect of surfactant and PEEP on lung volume.
Conclusions:
- Surfactant-treated neonates require cautious weaning from PEEP due to its significant impact on lung volume.
- Inadvertent end-distending pressure during FRC measurement can lead to inaccurate results in ventilated neonates.
Abstract:
Both surfactant replacement and positive end-expiratory pressure (PEEP) increase lung volume in infants with respiratory distress syndrome (RDS). We measured pulmonary mechanics and functional residual capacity (FRC) in 21 preterm infants with RDS, > 48 hr post-surfactant therapy (BW, 1,168 +/- 441 g; GA, 28.3 +/- 2.8 weeks; postnatal age, 3-7 days). A non-linear but significant increase in mean FRC was noted as PEEP increased from 2 to 5 cmH2O: 18.4 +/- 4.7 mL/kg at 2 cmH2O; 19.7 +/- 4.3 mL at 3 cmH2O; 22.6 +/- 5.5 ml/kg at 4 cmH2O; and 26.2 +/- 6.2 mL/kg at 5 cmH2O (P < 0.01). Because of the synergistic combined effect on lung volume, surfactant treated neonates should be weaned cautiously from PEEP during ventilatory management. Our study also suggests that the occurrence of inadvertent end-distending pressure during FRC measurement in the ventilated neonate lead to erroneous results.