Abstract
The interrelationships of compliance (CL), O2 transfer, CO2 excretion, and pulmonary circulation have not been explored in prematures with HMD. Using an esophageal balloon and pneumotach, CL was measured at intervals during titration of PEEP, together with arterial blood gases, in 7 prematures with HMD varying from 11h to 9d in age. As PEEP was varied stepwise upwards and downwards, an optimal value was found for CL. PaO2, and AaDO2. A 15 min. equilibration time was allowed at each PEEP setting, and the entire titration spanned 2-3 hrs. “Best PEEP” was different for CL, PaO2, and AaDO2, although best PaO2 and best AaDO2 were very similar. Interestingly, best PaO2 was at a significantly higher PEEP than best CL (mean 5 vs. 7.1cm H2O, P= < .05). PaCO2 rose at PEEPs of 6-9 in 4 patients, but was not limiting to “best PEEP.” The titration itself yielded an apparently beneficial “opening up” effect in 3 babies, in that repeat measurement of PaO2 and CL at the same PEEP showed improvement. Clinical estimations of PEEP were often not the same as recommended best PEEP, based on these titrations. In 3 cases PEEP was increased, in 2 it was decreased, and in 2 the previous setting was considered optimum. These data suggest that no single parameter defines “best PEEP,” but rather jt must be a judicious compromise.
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Avery, G., Naulty, C. WHAT IS BEST PEEP?. Pediatr Res 11, 567 (1977). https://doi.org/10.1203/00006450-197704000-01182
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DOI: https://doi.org/10.1203/00006450-197704000-01182
