- For preterm infants requiring conventional mechanical ventilation (CMV) for respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), evidence is lacking about optimal positive end-expiratory pressure (PEEP) level.
- Some low-quality evidence suggests advantage with oxygen-guided lung recruitment maneuver (LRM) in selecting level.
- Authors: “We do not believe that our current findings have implications for clinical practice.”
- Randomized trials needed.
Why this matters
- PEEP could mitigate ventilator-induced lung injury in this population.
- Unclear what PEEP level is optimal or how to find optimum.
- No trials of PEEP in BPD.
- 2 crossover trials compared low vs high PEEP levels in RDS (n=28).
- Trials did not report death or impairment.
- Oxygenation, carbon dioxide levels: no difference.
- 2 randomized controlled trials compared oxygen-guided LRM vs usual care to optimize PEEP (n=44).
- Mortality, BPD development: no difference.
- Favoring LRM: CMV duration; supplemental oxygen requirement; arterial/alveolar oxygen ratio.
- All evidence low-quality.
- Systematic review, meta-analysis, 4 studies of PEEP for preterm infants undergoing CMV for RDS or BPD (n=72).
- Outcomes: death by hospital discharge (RDS) or age 2 years (BPD); neurodevelopmental impairment at age 2 years.
- Funding: Vermont Oxford Network.
- Very small studies.
- In 1 trial, all participants had patent ductus arteriosus.