Effect of positive end expiratory pressure on functional residual capacity and compliance in surfactant-treated preterm infants
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Jürgen Dinger
Abstract
Positive end expiratory pressure is routinely used when ventilating preterm infants. Elevation of PEEP increases lung volume, as does surfactant treatment. The purpose of this study was to investigate the effect of various levels of PEEP within the range of 0.2 to 0.4 kPa on lung volume, compliance and gas exchange. We measured functional residual capacity, compliance of the respiratory system and arterial blood gases in 20 infants (median birth weight 1240 g, range 660–1690 g; median gestational age 28 weeks, range 24–32 weeks; postnatal age 3–4 days). The infants were studied at 72 hours after their last dose of natural surfactant. At this time the patients were routinely nursed at 0.3 kPa of PEEP, the PEEP level was lowered to 0.2 kPa or raised to 0.4 kPa in random order. The PEEP level was then changed to the third level 0.4 kPa or 0.2 kPa. Each new setting was maintained for 20 min before FRC, compliance and blood gases were measured. FRC was assessed using SF6 washout technique.
Increasing PEEP from 0.2 to 0.3 to 0.4 kPa resulted in increases in FRC (p < 0.01) and oxygenation (ns) in all infants. In 16 infants compliance decreased and paCO2 increased with elevation of PEEP. Only in 4 infants compliance increased and CO2 fell.
Conclusion: In the majority of our infants reduction of PEEP from 0.4 to 0.2 kPa resulted in increases in compliance and CO2 reduction. Our results might suggest that relatively low levels of PEEP < 0.3 kPa may be appropriate at 72 hours after surfactant replacement. Furthermore, these results underline the importance of PEEP test in clinical practice.
Copyright © 2001 by Walter de Gruyter GmbH & Co. KG
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- WAPM-Newsletter No 1
Articles in the same Issue
- Malignant disease in pregnancy
- Repeated ultrasound guided fetal injections of corticosteroid alter nervous system maturation in the ovine fetus
- Incidence and birth weight characteristics of twins born to mothers aged 40 years or more compared with 35-39 years old mothers: a population study
- Lipopolysaccharide stimulation of 70 kilo Dalton heat shock protein messenger ribonucleic acid production in cultured human fetal membranes
- Effect of positive end expiratory pressure on functional residual capacity and compliance in surfactant-treated preterm infants
- Neonatal nucleated red blood cell counts in twins
- Normalisation of a severely abnormal ductus venosus Doppler flow velocity waveform in a growth-retarded fetus with absent end-diastolic flow in the umbilical artery and congenital anomalies
- Acute iliac vein thrombosis in pregnancy treated successfully by streptokinase lysis: a case report
- Liquid ventilation in an infant with persistent interstitial pulmonary emphysema
- Renal vein thrombosis in a newborn with prothrombotic genetic risk factors
- Fetal pulse oximetry allows safe continuation of labor in the presence of mild-moderate non reassuring CTG
- WAPM-Newsletter No 1
