Effects of Sustained Lung Inflation, a lung recruitment maneuver in primary acute respiratory distress syndrome, in respiratory and cerebral outcomes in preterm infants

Grasso, Chiara; Sciacca, P; Giacchi, Valentina; Carpinato, C; Mattia, Carmine; Palano, Grazia Maria; Betta, Pasqua

doi:10.1016/j.earlhumdev.2014.12.002

Cited by 30 publications

(30 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are in accordance with all other retrospective studies [18,19,27,28] assessing SI. Only one [18] showed a decrease in BPD and severe IVH, but these results could be related to other interventions in the DR such as an individualized approach to intubation, more CPAP use, and novel thermoregulation interventions.…”

Section: Discussionsupporting

confidence: 93%

“…Our significant decrease in endotracheal intubation rate in the DR is in accordance with other retrospective studies [18,19] and 3 RCTs [20-22] on SI. However, in our study as in all retrospective studies in the DR, it is difficult to ascertain whether this decrease was related to our individualized LR maneuvers or to a longer time allowed to the infants to stabilize without intubation.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study

Kanaan

Bloch-Queyrat²,

Boubaya³

et al. 2020

BMC Pediatr

View full text Add to dashboard Cite

Background: Lung recruitment at birth has been advocated as an effective method of improving the respiratory transition at birth. Sustained inflations (SI) and dynamic positive end-expiratory pressure (PEEP) were assessed in clinical and animal studies to define the optimal level. Our working hypothesis was that very low gestational age infants (VLGAI) < 32 weeks' gestation require an individualized lung recruitment based on combining both manoeuvers. Methods: Between 2014 and 2016, 91 and 72 inborn VLGAI, requiring a respiratory support beyond a continuous positive airway pressure (CPAP) = 5 cmH2O, were enrolled before and after introducing these manoeuvers based on progressive increase in SI up to 15 s, with simultaneous gradual increase in PEEP up to 15 cmH2O, according to the cardiorespiratory response. Retrospective comparisons of the incidence of mechanical ventilation (MV) < 72 h of life, short-term and before discharge morbidity were then performed.Results: Among extremely low gestational age infants (ELGAI) < 29 weeks' gestation, the following outcomes decreased significantly: intubation (90 to 55%) and surfactant administration (54 to 12%) in the delivery room, MV (92 to 71%) and its mean duration < 72 h of life (45 h to 13 h), administration of a 2nd dose of surfactant (35 to 12%) and postnatal corticosteroids (52 to 19%), and the rate of bronchopulmonary dysplasia (23 to 5%). Among VLGAI, all of these results were also significant. Neonatal mortality and morbidity were not different. Conclusions:In our setting, combining two individualized lung recruitment maneuvers at birth was feasible and may be beneficial on short-term and before discharge pulmonary outcomes. A randomized controlled trial is needed to confirm these results.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study

Kanaan

Bloch-Queyrat²,

Boubaya³

et al. 2020

BMC Pediatr

View full text Add to dashboard Cite

show abstract

“…Further clinical studies of SI were not published until 1999. Since then one case series,29 three retrospective cohort studies,13 14 16 four randomised controlled trials (RCTs)11 12 15 17 and a meta-analysis30 have described outcomes following delivery of a SI.…”

Section: Si At Birth: What Is Known?mentioning

confidence: 99%

“…All three of the historical cohort studies reported a reduction in intubation and mechanical ventilation rates following a SI (table 1). 13 14 16 A SI was also associated with a reduced need for exogenous surfactant14 16 and postnatal steroids,14 shorter duration of mechanical ventilation14 16 and less IVH13 and BPD 13 14. Caution is needed in interpreting these findings.…”

Section: Si At Birth: What Is Known?mentioning

confidence: 99%

Sustained lung inflation at birth: what do we know, and what do we need to know?

McCall

Davis

Owen

et al. 2015

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

A sustained inflation has been advocated as a potential method of augmenting lung aeration at birth. Clinical trials have suggested that a sustained inflation may lead to a reduced need for intubation and ventilation in the first few days of life, without cardiovascular compromise or increased lung injury. Despite this, a sustained inflation is not currently a standard of practice, mainly due to a lack of clarity regarding the optimal delivery method. Animal trials have sought to refine delivery techniques. This review will outline current recommendations regarding a sustained inflation, discuss potential strategies for its optimal delivery and suggest priorities for future research.

show abstract

“…The role of recruitment maneuvers on subsequent respiratory therapies may also be important. Clinical studies of SI have suggested a reduced need for surfactant replacement following a SI (24)(25)(26). However, in preterm lambs, pretreatment with surfactant improves the lung injury patterns and response to a SI compared with post-SI surfactant (12), suggesting a recruitment maneuver may also influence subsequent respiratory therapies (8).…”

mentioning

confidence: 99%

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

et al. 2016

View full text Add to dashboard Cite

Background:To describe the interrelationship between antenatal steroids, exogenous surfactant, and two approaches to lung recruitment at birth on oxygenation and respiratory system compliance (C dyn ) in preterm lambs. Methods: Lambs (n = 63; gestational age 127 ± 1 d) received either surfactant at 10-min life (Surfactant), antenatal corticosteroids (Steroid), or neither (Control). Within each epoch lambs were randomly assigned to a 30-s 40 cmH 2 O sustained inflation (SI) or an initial stepwise positive end-expiratory pressure (PEEP) open lung ventilation (OLV) maneuver at birth. All lambs then received the same management for 60-min with alveolar-arterial oxygen difference (AaDO 2 ) and C dyn measured at regular time points. results: Overall, the OLV strategy improved C dyn and AaDO 2 (all epochs except Surfactant) compared to SI (all P < 0.05; twoway ANOVA). Irrespective of strategy, C dyn was better in the Steroid group in the first 10 min (all P < 0.05). Thereafter, C dyn was similar to Steroid epoch in the OLV + Surfactant, but not SI + Surfactant group. OLV influenced the effect of steroid and surfactant (P = 0.005) on AaDO 2 more than SI (P = 0.235). conclusions: The antenatal state of the lung influences the type and impact of a recruitment maneuver at birth. The effectiveness of surfactant maybe enhanced using PEEPbased time-dependent recruitment strategies rather than approaches solely aimed at initial lung liquid clearance.i t is widely agreed that the optimal support of the preterm lung involves the combination of antenatal corticosteroid exposure, exogenous surfactant therapy, and early application of lung protective respiratory support strategies (1). Together, these therapies reduce the potential of assisted ventilation to injure the developmentally immature, surfactant-deficient preterm lung. The roles of early exogenous surfactant therapy (2) and antenatal corticosteroids (3) in improving lung mechanics, functional residual capacity, and reducing respiratory support are well established. The optimal respiratory support strategies are still debated (4-7).Ideally, lung protective respiratory support should commence during transition to ex utero life (1,8). During this period, the infant must rapidly clear lung liquid, aerate the lung, establish a functional residual capacity, and commence tidal ventilation, processes influenced by the intrinsic mechanical properties of the lung as well as the applied respiratory strategy (5,6,9-13). The optimal approach in preterm infants remains unclear but broadly requires an inflating pressure to drive fetal lung fluid into the alveoli and allow lung aeration, and positive end-expiratory pressure (PEEP) to maintain aeration and prevent fluid efflux back into the airways (14-17). In preterm animals, using an initial stepwise PEEP or open lung ventilation (OLV) approach during tidal ventilation from birth improves aeration and short-term respiratory outcomes in preterm animals via utilizing hysteresis and time dependency (6,11). However, clinical trials at birth...

show abstract

Effects of Sustained Lung Inflation, a lung recruitment maneuver in primary acute respiratory distress syndrome, in respiratory and cerebral outcomes in preterm infants

Cited by 30 publications

References 19 publications

Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study

Feasibility of combining two individualized lung recruitment maneuvers at birth for very low gestational age infants: a retrospective cohort study

Sustained lung inflation at birth: what do we know, and what do we need to know?

The interrelationship of recruitment maneuver at birth, antenatal steroids, and exogenous surfactant on compliance and oxygenation in preterm lambs

Contact Info

Product

Resources

About