Positive end expiratory pressure is routinely used when
ventilating preterm infants. Elevation of PEEP increases
lung volume, as does surfactant treatment. The purpose
of this study was to investigate the effect of various
levels of PEEP within the range of 0.2 to 0.4 kPa on
lung volume, compliance and gas exchange. We measured
functional residual capacity, compliance of the
respiratory system and arterial blood gases in 20 infants
(median birth weight 1240 g, range 660–1690 g; median
gestational age 28 weeks, range 24–32 weeks;
postnatal age 3–4 days). The infants were studied at 72
hours after their last dose of natural surfactant. At this
time the patients were routinely nursed at 0.3 kPa of
PEEP, the PEEP level was lowered to 0.2 kPa or raised
to 0.4 kPa in random order. The PEEP level was then
changed to the third level 0.4 kPa or 0.2 kPa. Each new
setting was maintained for 20 min before FRC, compliance
and blood gases were measured. FRC was assessed
using SF6 washout technique.
Increasing PEEP from 0.2 to 0.3 to 0.4 kPa resulted in
increases in FRC (p < 0.01) and oxygenation (ns) in all
infants. In 16 infants compliance decreased and paCO2
increased with elevation of PEEP. Only in 4 infants
compliance increased and CO2 fell.
Conclusion: In the majority of our infants reduction
of PEEP from 0.4 to 0.2 kPa resulted in increases in
compliance and CO2 reduction. Our results might suggest
that relatively low levels of PEEP < 0.3 kPa may
be appropriate at 72 hours after surfactant replacement.
Furthermore, these results underline the importance of
PEEP test in clinical practice.
The Journal of Perinatal Medicine is a truly international forum covering the entire field of perinatal medicine. It is an essential news source for all those obstetricians, neonatologists, perinatologists and allied health professionals who wish to keep abreast of progress in perinatal and related research.
01 Jan 1973
Eduardo Bancalari, Joseph Chappelle, Frank A. Chervenak, Vincenzo D'Addario, Mehmet R. Genc, Anne Greenough, Amos Grunebaum, Asim Kurjak M.D., Roberto Romero and Ivica Zalud, MD PhD