Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO 2 Levels for Optimal Ventilation Using Open-Lung Strategies

Frontiers in Pediatrics

article

Funda Tuzun¹  Burak Deliloglu¹  Merve Meryem Cengiz¹  Burcin Iscan²  Nuray Duman¹  Hasan Ozkan¹ 

[1] Division of Neonatology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine;Division of Neonatology, Department of Pediatrics, Tinaztepe University Faculty of Medicine

关键词: HFOV;    volume guarantee;    lung recruitment;    VThf;    DCO 2;    frequency;    RDS;    lung-protective strategies;   

DOI  :  10.3389/fped.2020.00105

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

High frequency oscillatory ventilation with volume-guarantee (HFOV-VG) is a promising lung protective ventilator mode for the treatment of respiratory failure in newborns. However, indicators of optimal ventilation during HFOV-VG mode are not identified yet. In this study, we aimed to evaluate optimal high-frequency tidal volume (VThf) and the dissociation coefficient of CO 2 (DCO 2 ) levels to achieve normocapnia during HFOV-VG after lung recruitment in very low birthweight infants with respiratory distress syndrome (RDS). Preterm babies under the 32nd postmenstrual week with severe RDS that received HFOV-VG using open-lung strategy between January 2014 and January 2019 were retrospectively evaluated. All included patients were treated with the Dräger Babylog VN500 ventilator in the HFOV-VG mode. In total, 53 infants with a mean gestational age of 26.8 ± 2.3 weeks were evaluated. HFOV mean optimal airway pressure (MAPhf) level after lung recruitment was found to be 10.2 ± 1.7 mbar. Overall, the mean applied VThf per kg was 1.64 ± 0.25 mL/kg in the study sample. To provide normocapnia, the mean VThf was 1.61 ± 0.25 mL/kg and the mean DCO 2 corr was 29.84 ± 7.88 [mL/kg] 2 /s. No significant correlation was found between pCO 2 levels with VThf (per kg) or DCO 2 corr levels. VThf levels to maintain normocarbia were significantly lower with 12 Hz frequency compared to 10 Hz frequency (1.50 ± 0.24 vs. 1.65 ± 0.25 mL/ kg, p < 0.001, respectively). A weak but significant positive correlation was found between mean airway pressure (MAPhf) and VThf levels. To our knowledge, this is the largest study to evaluate the optimal HFOV-VG settings in premature infants with RDS, using the open-lung strategy. According to the results, a specific set of numbers could not be recommended to achieve normocarbia. Following the trend of each patient and small adjustments according to the closely monitored pCO 2 levels seems logical.

【 授权许可】

CC BY