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Gradual aeration at birth is more lung protective than a sustained inflation in preterm lambs

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Tingay, DG, Pereira-Fantini, PM, Oakley, R, McCall, KE, Perkins, EJ, Miedema, M, Sourial, M, Thomson, J, Waldmann, A, Dellaca, RL, Davis, PG and Dargaville, PA 2019 , 'Gradual aeration at birth is more lung protective than a sustained inflation in preterm lambs' , American Journal of Respiratory and Critical Care Medicine, vol. 200, no. 5 , pp. 608-616 , doi: 10.1164/rccm.201807-1397OC.

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Abstract

Rationale: 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.Objectives: To examine the effect of gradual and rapid aeration at birth on: 1) the spatiotemporal volume conditions of the lung; and 2) resultant regional lung injury.Methods: Preterm lambs (125 ± 1 d gestation) were randomized at birth to receive: 1) tidal ventilation without an intentional recruitment (no-recruitment maneuver [No-RM]; n = 19); 2) sustained inflation (SI) until full aeration (n = 26); or 3) tidal ventilation with an initial escalating/de-escalating (dynamic) positive end-expiratory pressure (DynPEEP; n = 26). Ventilation thereafter continued for 90 minutes at standardized settings, including PEEP of 8 cm H2O. Lung mechanics and regional aeration and ventilation (electrical impedance tomography) were measured throughout and correlated with histological and gene markers of early lung injury.Measurements and Main Results: DynPEEP significantly improved dynamic compliance (P P = 0.0006). The nondependent lung was preferential ventilated by 5 minutes in all groups, with ventilation only becoming uniform with time in the No-RM and DynPEEP groups. All strategies generated similar nondependent lung injury patterns. Only an SI caused greater upregulation of dependent lung gene markers compared with unventilated fetal controls (P Conclusions: Rapidly aerating the preterm lung at birth creates heterogeneous volume states, producing distinct regional injury patterns that affect subsequent tidal ventilation. Gradual aeration with tidal ventilation and PEEP produced the least lung injury.

Item Type: Article
Authors/Creators:Tingay, DG and Pereira-Fantini, PM and Oakley, R and McCall, KE and Perkins, EJ and Miedema, M and Sourial, M and Thomson, J and Waldmann, A and Dellaca, RL and Davis, PG and Dargaville, PA
Keywords: lung injury, lung mechanics, preterm, respiratory transition, sustained inflation
Journal or Publication Title: American Journal of Respiratory and Critical Care Medicine
Publisher: Amer Thoracic Soc
ISSN: 1073-449X
DOI / ID Number: 10.1164/rccm.201807-1397OC
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Copyright © 2019 by the American Thoracic Society

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