Lung recruitment in neonatal high‐frequency oscillatory ventilation with volume‐guarantee

Solís García, Gonzalo; González Pacheco, Noelia; Ramos Navarro, Cristina; Vigil Vázquez, Sara; Gutiérrez Vélez, Ana; Merino Hernández, Amaia; Rodríguez Sánchez De la Blanca, Ana; Sánchez Luna, Manuel Ramón

Lung recruitment in neonatal high‐frequency oscillatory ventilation with volume‐guarantee

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Official URL

https://onlinelibrary.wiley.com/doi/10.1002/ppul.26124

Publication date

2022

Authors

Solís García, Gonzalo

González Pacheco, Noelia

Ramos Navarro, Cristina

Vigil Vázquez, Sara

Gutiérrez Vélez, Ana

Merino Hernández, Amaia

Rodríguez Sánchez De la Blanca, Ana

Sánchez Luna, Manuel Ramón

Publisher

Wiley

Citations

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URI

https://hdl.handle.net/20.500.14352/99338

Citation

Solis‐Garcia G, González‐Pacheco N, Ramos‐Navarro C, et al. Lung recruitment inneonatal high‐frequency oscillatory ventilation with volume‐guarantee. Pediatric Pulmonology.2022;57:3000‐3008. doi:10.1002/ppul.26124

Abstract

Background and objectives: The optimal lung volume strategy during high-frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV-VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV-VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure. Design and methods: The prospective observational study was done in a tertiary-level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV-VG in preterm infants with severe respiratory failure. Results: Twenty-seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23-25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2 O (IQR: 10-13), median critical lung opening mPaw during recruitment was 14 cm H2 O (IRQ: 12-16), and median optimal mPaw was 12 cm H2 O (IQR: 10-14, p < 0.01). Recruitment maneuvers were associated with an improvement in oxygenation (FiO2 : 65.0 vs. 45.0, p < 0.01, SpO2/FiO2 ratio: 117 vs. 217, p < 0.01). ΔPhf decreased significantly after lung recruitment (mean amplitude: 23.0 vs. 16.0, p < 0.01). Conclusion: In preterm infants with severe respiratory failure, the lung recruitment process can be effectively guided by ΔPhf on HFOV-VG.