High-frequency oscillatory ventilation in neonatal RDS: initial volume optimization and respiratory mechanics |
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Authors: | Kalenga, Masendu Battisti, Oreste Francois, Anne Langhendries, Jean-Paul Gerstmann, Dale R. Bertrand, Jean-Marie |
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Abstract: | To determine whetherinitial lung volume optimization influences respiratory mechanics,which could indicate the achievement of optimal volume, we studied 17 premature infants with respiratory distress syndrome (RDS) assisted byhigh-frequency oscillatory ventilation. The continuous distendingpressure (CDP) was increased stepwise from 6-8 cmH2Oup to optimal CDP (OCDP), i.e., that allowing good oxygenation with thelowest inspired O2 fraction. Respiratory systemcompliance (Crs) and resistance were concomitantlymeasured. Mean OCDP was 16.5 ± 1.2 cmH2O. InspiredO2 fraction could be reduced from an initial level of 0.73 ± 0.17 to 0.33 ± 0.07. However, Crs (0.45 ± 0.14ml · cmH2O 1 · kg 1at starting CDP point) remained unchanged through lung volume optimization but appeared inversely related to OCDP. Similarly, respiratory system resistance was not affected. We conclude that thereis a marked dissociation between oxygenation improvement and Crsprofile during the initial phase of lung recruitment by earlyhigh-frequency oscillatory ventilation in infants with RDS. Thusoptimal lung volume cannot be defined by serial Crs measurement. At themost, low initial Crs suggests that higher CDP will be needed. |
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