Higher PEEP reduces duration of mechanical ventilation in neonatal respiratory distress syndrome of late preterm and term newborn infants

TL;DR

Using higher PEEP in ventilating late preterm and term infants with respiratory distress reduces ventilation and hospital time without increasing complications.

Contribution

Demonstrates that higher PEEP improves outcomes in neonatal respiratory distress syndrome treatment.

Findings

Higher PEEP reduced mechanical ventilation duration (P=0.008) and oxygen inhalation (P=0.002).

Higher PEEP lowered FiO2 (P=0.001) and oxygenation index (P=0.048) at 24 hours.

Higher PEEP shortened hospitalization duration (P=0.033) without increasing complications.

Abstract

Mechanical ventilation was frequently conducted in late preterm and term newborn infants because of their severity of neonatal respiratory distress syndrome (NRDS), but the level of positive end expiratory pressure (PEEP) used was not explicit. This study aimed to investigate the efficacy and safety of higher-PEEP in the treatment of NRDS in these infants. Initially, 80 newborn late preterm and term infants diagnosed with NRDS were enrolled, a total of 26 infants were excluded because they were not within the gestational age range of 34+ 0 to 39+ 6 weeks or did not receive mechanical ventilation. Of 54 eligible infants, 6 were excluded: 3 for pre-existing pneumothorax before mechanical ventilation, 1 for hospital transfer, 1 for withdrawal of treatment, and 1 for misdiagnosis with transient tachypnea. Ultimately, 48 infants remained. Following a simple randomization procedure, 23 were assigned to higher-PEEP group and 25 to the control group. The duration of mechanical ventilation was regarded as the primary outcome. We also collected and analyzed data of other clinical factors. We found that higher-PEEP group had significantly shorter durations of mechanical ventilation (P = 0.008) and oxygen inhalation (P = 0.002) compared to the control. Additionally, the fraction of inspired oxygen (FiO2) (P = 0.001) and oxygenation index (OI) (P = 0.048) at 24 h after birth were lower in higher-PEEP group compared to the control. Furthermore, higher-PEEP group had a shorter duration of hospitalization (P = 0.033). However, no significant differences were observed in the comparisons of complications between the two groups. In summary, higher PEEP could reduce the duration of mechanical ventilation by preserving adequate functional residual capacity, without increasing rates of adverse effects.

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