Document Detail

Acute effects of PEEP on tidal volume and respiratory center output during synchronized ventilation in preterm infants.
MedLine Citation:
PMID:  16779842     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Positive end expiratory pressure (PEEP) is routinely used in mechanically ventilated preterm infants to maintain lung volume. An acute increase in PEEP can affect lung mechanics and tidal volume, but it is unknown if these effects elicit compensatory changes in respiratory center output. OBJECTIVES: To investigate the acute effects of changes in PEEP on tidal volume (V(T)), lung compliance (C(L)), and respiratory center output (RCO) during synchronized intermittent mandatory ventilation (SIMV) in preterm infants at different levels of basal respiratory drive. METHODS: Preterm infants were studied during SIMV at three levels of PEEP (2, 4, and 6 cm H(2)O for 2-3 min each) and at two levels of inspired CO(2). Peak inspiratory pressure (PIP) was adjusted to maintain the same delta pressure at the airway. RCO was assessed by measuring total diaphragmatic electrical activity. The level of inspired CO(2) was adjusted by modifying the instrumental dead space. RESULTS: Sixteen preterm infants GA: 25 +/- 2 weeks, BW: 786 +/- 242 g, age: 18 +/- 15 days, SIMV: rate 14 +/- 3 b/min, Ti: 0.35 +/- 0.01 s, PIP: 16 +/- 1 cm H(2)O, and FiO(2): 0.31 +/- 0.06 were studied. At both levels of inspired CO(2), C(L), V(T), and V'(E) from spontaneous and mechanical breaths decreased significantly with higher PEEP. RCO did not change, but at lower respiratory drive, there was a trend towards an increase in RCO with higher PEEP. CONCLUSION: Higher PEEP levels can have acute negative effects on lung mechanics and ventilation in preterm infants without a sufficient compensatory increase in RCO.
Ximena Alegría; Nelson Claure; Yoshirou Wada; Cristian Esquer; Carmen D'Ugard; Eduardo Bancalari
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric pulmonology     Volume:  41     ISSN:  8755-6863     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-07     Completed Date:  2006-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  759-64     Citation Subset:  IM    
Department of Pediatrics, Division of Newborn Medicine, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
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MeSH Terms
Infant, Newborn
Infant, Premature / physiology*
Lung Compliance
Positive-Pressure Respiration* / methods
Respiratory Dead Space
Respiratory Mechanics*
Tidal Volume*

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