Role of lung ultrasound in the assessment of recruitment maneuvers in ventilated preterm neonates with respiratory distress syndrome and its correlation with tracheal IL-6 levels: A randomized controlled trial

Abstract

BACKGROUND: This study’s aim is to evaluate lung ultrasound (LUS) efficacy in detecting opening and closing lung pressures and its correlation with the tracheal interleukin 6 (IL-6) level. METHOD: This single-blinded randomized controlled study was done at Ain Shams University Children’s Hospital neonatal intensive care units, Egypt. It consists of 44 mechanically ventilated preterm neonates with Respiratory Distress Syndrome (RDS). Initial LUS assessment was done followed by randomization to one of 2 groups; group I: 22 patients underwent LUS guided RM and group II: 22 patients underwent non-ultrasound guided RM. Tracheal IL-6 level was measured before and after RM in both groups. RESULTS: The LUS scores showed a sensitivity of 86.7% , specificity of 62.10% and accuracy of 70.45% at the cut-off point >B1 grade. After RM, there was a higher percentage of changes in mean airway pressure (p = 0.03), FiO2 (p = 0.01), PaO2/FiO2 ratio (p = 0.01), and IL-6 (p < 0.01) in group I. The duration of oxygen requirement (6 vs.13.5 days, p = 0.01), invasive ventilation (3 vs.5.5 days, p = 0.03), non-invasive ventilation (2.5 vs. 5 days, p = 0.02) and NICU stay (21.5 vs. 42.5 days, p = 0.03) was less in group I. A positive correlation between reaeration score and the duration of O2 requirement (p = 0.002), duration of invasive ventilation (p = 0.001), NICU length of stay (p = 0.002) and negative correlation with PaO2/FiO2 ratio before RM (p = 0.012). The best cut-off point for the reaeration score is >21 with a sensitivity of 75% , specificity of 71.43% and area under the curve of 78.1% . CONCLUSION: LUS-guided RM achieved earlier lowest FiO2, shorter O2 dependency, lesser NICU stay and marked decrease in lung inflammation by decreasing atelectotrauma and shortening the duration of invasive ventilation.

Lung UltraSound Targeted Recruitment (LUSTR): A Novel Protocol to Optimize Open Lung Ventilation in Critically Ill Neonates

“…A recent randomized controlled trial demonstrated the beneficial impact of LUS in guiding elective LRMs as opposed to the oxygenation-guided method, on a population of preterm infants before the first surfactant administration [ 6 ]. Infants enrolled in this trial were all suffering from RDS, a homogenous lung disease, known to respond well to lung recruitment, including oxygenation-guided maneuvers [ 15 , 23 ].…”

“…In the Oxygenation-guided group, the procedure in HFOV was performed as described in previous reports on neonates [ 6 , 15 ]. LRMs on conventional ventilation in neonates follow very different protocols [ 16 ].…”

“…Open lung ventilation represents a well-known approach to evenly distribute the tidal volume throughout the mechanically ventilated lungs, through lung recruitment maneuvers (LRMs) [ 3 , 4 , 5 ], with the aim to minimize ventilator-induced lung injury (VILI) and improve the overall outcome. In a recent randomized trial [ 6 ], elective LUS-guided recruitment, performed in premature infants suffering from respiratory distress syndrome (RDS), was proved to be more effective than the standard oxygenation-based procedure in terms of the duration of invasive ventilation, length of stay, and intra-alveolar concentration of IL-6 [ 6 ]. However, the role of ultrasound-guided LRMs as a rescue approach in critically ill infants has not been evaluated yet.…”

The Value of Lung Ultrasound Score in Neonatology

“…LUS 0 had high reliability in prognosing invasive ventilation on DOL 3 (AUC = 0.845; 95% CI: 0.738–0.951; p < 0.001) ( 25 ). Abushady et al also found that patients who underwent LUSs guided recruitment maneuver achieved earlier lowest FiO 2 , shorter O 2 dependency, shortening the duration of invasive ventilation, and marked decrease in lung inflammation ( 56 ). A prospective double-blind study was conducted in infants with a GA <34 weeks with RDS by evaluation with LUS and CXR on admission ( 17 ).…”

Lungenultraschall in der Neonatologie

“…B. anhand des Lungenultraschalls entschieden, Surfactant zu geben (Lungenultraschall binnen 1 Stunde in 6 Regionen, Score > 6 = Surfactant-Mangel), erhielten Frühgeborene das Surfactant gleich häufig, allerdings deutlich früher [10]. Der Lungenultraschall kann für die Rekrutierung an der konventionellen Beatmung [18], die Indikation zur Anlage einer Thoraxdrainage [8] oder einer bronchoalveolären Lavage verwendet werden [19].…”