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Acute effects of PEEP on tidal volume and respiratory center output during synchronized ventilation in preterm infants
Author(s) -
Alegría Ximena,
Claure Nelson,
Wada Yoshirou,
Esquer Cristian,
D'Ugard Carmen,
Bancalari Eduardo
Publication year - 2006
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.20436
Subject(s) - medicine , tidal volume , anesthesia , ventilation (architecture) , pulmonary compliance , mechanical ventilation , respiratory physiology , positive end expiratory pressure , respiratory system , respiratory minute volume , dead space , peak inspiratory pressure , mean airway pressure , lung volumes , respiratory rate , functional residual capacity , lung , heart rate , blood pressure , mechanical engineering , engineering
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. Pediatr Pulmonol. 2006; 41: 759–764. © 2006 Wiley‐Liss, Inc.