Variation in Positive End-Expiratory Pressure Levels for Mechanically Ventilated Extremely Low Birth Weight Infants - 23/02/18
Abstract |
Objective |
To test the hypothesis that significant positive end-expiratory pressure (PEEP) level variation exists between neonatal centers.
Study design |
We performed a secondary analysis cohort study of the Nasal Intermittent Positive-Pressure Ventilation trial. Our study population was extremely low birth weight infants requiring mechanical ventilation within 28 days of life. The exposure was neonatal center; 34 international centers participated in the trial. Subjects from centers with fewer than 5 eligible cases were excluded. The main outcome was the maximal PEEP level used during the first course of mechanical ventilation. Infant characteristics judged a priori to directly influence clinical PEEP level selection and all characteristics associated with PEEP at P <.05 in bivariable analyses were included with and without center in multivariable linear regression models. Variation in PEEP level use between centers following adjustment for infant characteristics was assessed.
Results |
A total of 278 extremely low birth weight infants from 17 centers were included. Maximal PEEP ranged from 3 to 9 cm H2O, mean = 5.7 (SD = 0.9). Significant variation between centers remained despite adjustment for infant characteristics (P < .0001). Further, center alone explained a greater proportion of the PEEP level variation than all infant characteristics combined.
Conclusions |
Marked variation in PEEP levels for extremely low birth weight infants exists between neonatal centers. Research providing evidence-based guidance for this important aspect of respiratory care in preterm infants at high risk of lung injury is needed.
Trial registration |
ClinicalTrials.gov: NCT00433212.
Le texte complet de cet article est disponible en PDF.Keywords : infant, premature, respiration, artificial, ventilator-induced lung injury, respiratory distress syndrome, newborn, bronchopulmonary dysplasia
Abbreviations : AIC, BPD, ELBW, FiO2, NIPPV, PEEP
Plan
Supported by the National Institutes of Health Institutional National Research Service Award (2T32HD060550-06 to N.B.) and the Canadian Institutes of Health Research (MCT-80246 to H.K.) for the Nasal Intermittent Positive-Pressure Ventilation trial. D.M. received honoraria from Chiesi Limited for teaching sponsored neonatal ventilation workshops. The other authors declare no conflicts of interest. |
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Portions of this study were presented as an abstract at the European Society for Paediatric and Neonatal Intensive Care Annual Meeting, June 6-9, 2017, Lisbon, Portugal. |
Vol 194
P. 28 - mars 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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