Gradual Aeration at Birth Is More Lung Protective Than a Sustained Inflation in Preterm Lambs

The preterm lung is susceptible to injury during transition to air breathing at birth. It remains unclear whether rapid or gradual lung aeration at birth causes less lung injury. To examine the effect of gradual and rapid aeration at birth on: ) the spatiotemporal volume conditions of the lung; and...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2019-09, Vol.200 (5), p.608-616
Main Authors: Tingay, David G, Pereira-Fantini, Prue M, Oakley, Regina, McCall, Karen E, Perkins, Elizabeth J, Miedema, Martijn, Sourial, Magdy, Thomson, Jessica, Waldmann, Andreas, Dellaca, Raffaele L, Davis, Peter G, Dargaville, Peter A
Format: Article
Language:English
Subjects:
Animals
Animals, Newborn
Female
Gene expression
Humans
Infant, Newborn
Lung Injury - therapy
Male
Models, Animal
Newborn babies
Pregnancy
Premature birth
Premature Birth - physiopathology
Protective Factors
Respiration, Artificial - methods
Respiratory system
Sheep
Systematic review
Time Factors
Tomography
Ventilators
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Summary:The preterm lung is susceptible to injury during transition to air breathing at birth. It remains unclear whether rapid or gradual lung aeration at birth causes less lung injury. To examine the effect of gradual and rapid aeration at birth on: ) the spatiotemporal volume conditions of the lung; and ) resultant regional lung injury. Preterm lambs (125 ± 1 d gestation) were randomized at birth to receive: ) tidal ventilation without an intentional recruitment (no-recruitment maneuver [No-RM];  = 19); ) sustained inflation (SI) until full aeration (  = 26); or ) tidal ventilation with an initial escalating/de-escalating (dynamic) positive end-expiratory pressure (DynPEEP;  = 26). Ventilation thereafter continued for 90 minutes at standardized settings, including PEEP of 8 cm H O. Lung mechanics and regional aeration and ventilation (electrical impedance tomography) were measured throughout and correlated with histological and gene markers of early lung injury. DynPEEP significantly improved dynamic compliance (  
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201807-1397OC