Effect of sustained inflation vs. stepwise PEEP strategy at birth on gas exchange and lung mechanics in preterm lambs

Abstract

Background:Sustained inflation (SI) at birth facilitates establishment of functional residual capacity (FRC) in the preterm lung, but the ideal lung recruitment strategy is unclear. We have compared the effect of SI and a stepwise positive end-expiratory pressure (PEEP; SEP) strategy in a preterm model.Methods:127 d gestation lambs received either 20-s SI (n = 9) or 2 cmH 2 O stepwise PEEP increases to 20 cmH 2 O every 10 inflations, and then decreases to 6 cmH 2 O (n = 10). Ventilation continued for 70 min, with surfactant administered at 10 min. Alveolar-arterial oxygen gradient (AaDO 2), compliance (C dyn), end-expiratory thoracic volume (EEV RIP; respiratory inductive plethysmography), a..