Acute effects of PEEP on tidal volume and respiratory center output during synchronized ventilation in preterm infants

Ximena Alegría, Nelson R Claure, Yoshirou Wada, Cristian Esquer, Carmen D'Ugard, Eduardo Bancalari

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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 (VT), lung compliance (CL), 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 H2O for 2-3 min each) and at two levels of inspired CO2. 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 CO2 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 H2O, and FiO2: 0.31±0.06 were studied. At both levels of inspired CO2, 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.

Original languageEnglish
Pages (from-to)759-764
Number of pages6
JournalPediatric Pulmonology
Volume41
Issue number8
DOIs
StatePublished - Aug 1 2006

Fingerprint

Respiratory Center
Positive-Pressure Respiration
Tidal Volume
Premature Infants
Ventilation
Mechanics
Pressure
Lung
Lung Compliance

Keywords

  • Compliance
  • Positive end expiratory pressure
  • Preterm infant
  • Respiratory center output
  • Tidal volume

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Acute effects of PEEP on tidal volume and respiratory center output during synchronized ventilation in preterm infants. / Alegría, Ximena; Claure, Nelson R; Wada, Yoshirou; Esquer, Cristian; D'Ugard, Carmen; Bancalari, Eduardo.

In: Pediatric Pulmonology, Vol. 41, No. 8, 01.08.2006, p. 759-764.

Research output: Contribution to journalArticle

@article{8f939fe274954bef82d4d3e0228e371c,
title = "Acute effects of PEEP on tidal volume and respiratory center output during synchronized ventilation in preterm infants",
abstract = "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 (VT), lung compliance (CL), 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 H2O for 2-3 min each) and at two levels of inspired CO2. 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 CO2 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 H2O, and FiO2: 0.31±0.06 were studied. At both levels of inspired CO2, 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.",
keywords = "Compliance, Positive end expiratory pressure, Preterm infant, Respiratory center output, Tidal volume",
author = "Ximena Alegr{\'i}a and Claure, {Nelson R} and Yoshirou Wada and Cristian Esquer and Carmen D'Ugard and Eduardo Bancalari",
year = "2006",
month = "8",
day = "1",
doi = "10.1002/ppul.20436",
language = "English",
volume = "41",
pages = "759--764",
journal = "Pediatric Pulmonology",
issn = "8755-6863",
publisher = "Wiley-Liss Inc.",
number = "8",

}

TY - JOUR

T1 - Acute effects of PEEP on tidal volume and respiratory center output during synchronized ventilation in preterm infants

AU - Alegría, Ximena

AU - Claure, Nelson R

AU - Wada, Yoshirou

AU - Esquer, Cristian

AU - D'Ugard, Carmen

AU - Bancalari, Eduardo

PY - 2006/8/1

Y1 - 2006/8/1

N2 - 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 (VT), lung compliance (CL), 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 H2O for 2-3 min each) and at two levels of inspired CO2. 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 CO2 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 H2O, and FiO2: 0.31±0.06 were studied. At both levels of inspired CO2, 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.

AB - 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 (VT), lung compliance (CL), 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 H2O for 2-3 min each) and at two levels of inspired CO2. 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 CO2 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 H2O, and FiO2: 0.31±0.06 were studied. At both levels of inspired CO2, 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.

KW - Compliance

KW - Positive end expiratory pressure

KW - Preterm infant

KW - Respiratory center output

KW - Tidal volume

UR - http://www.scopus.com/inward/record.url?scp=33746589900&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33746589900&partnerID=8YFLogxK

U2 - 10.1002/ppul.20436

DO - 10.1002/ppul.20436

M3 - Article

C2 - 16779842

AN - SCOPUS:33746589900

VL - 41

SP - 759

EP - 764

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

SN - 8755-6863

IS - 8

ER -