Relationship between respiratory impedance and positive end-expiratory pressure in mechanically ventilated neonates

Raffaele L. Dellacà, C. Veneroni, V. Vendettuoli, E. Zannin, P. G. Matassa, A. Pedotti, M. Colnaghi, F. Mosca

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the feasibility of forced oscillation technique (FOT) measurements at the bedside and to describe the relationship between positive end-expiration pressure (PEEP) and lung mechanics in different groups of ventilated infants. Methods: Twenty-eight infants were studied: 5 controls, 16 newborns with respiratory distress syndrome (RDS) and 7 chronically ventilated newborns that developed bronchopulmonary dysplasia. An incremental/decremental PEEP trial was performed by changing PEEP in 1-min steps of 1 cmH2O between 2 and 10 cmH2O. Forced oscillations at 5 Hz were superimposed on the ventilator waveform. Pressure and flow, measured at the inlet of the ETT, were used to compute resistance (Rrs) and reactance (Xrs). Results: In controls Rrs and Xrs were on average 41 ± 21 and -22 ± 6 cmH 2O s/l respectively and were almost unaffected by PEEP. RDS infants presented similar Rrs (48 ± 25 cmH2O s/l) and reduced Xrs (-71 ± 19 cmH2O s/l) at the beginning of the trial. Two behaviours were observed as PEEP was increased: in extremely low birth weight infants Xrs decreased with PEEP with marked hysteresis; in very low and low birth weight infants Xrs and Rrs were less PEEP dependent. Chronically ventilated infants had very high Rrs and very negative Xrs values at very low PEEPs (121 ± 41 and -95 ± 13 cmH2O s/l at PEEP = 2 cmH2O) that markedly changed as PEEP exceeded 3-4 cmH2O. Conclusions: Rrs and Xrs measurement in preterm newborns is feasible, and data are representative of the lung mechanics and very sensitive to its changes with PEEP, making FOT a promising technique for the non-invasive bedside titration of mechanical ventilation in preterm newborns.

Original languageEnglish
Pages (from-to)511-519
Number of pages9
JournalIntensive Care Medicine
Volume39
Issue number3
DOIs
Publication statusPublished - Mar 2013

Keywords

  • Forced oscillation technique
  • Lung mechanics
  • Mechanical ventilation
  • Newborns
  • Positive end-expiratory pressure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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