Ventilator Pressure and Optimization of Compliance and Hemodynamics

Conditions studied

Bronchopulmonary Dysplasia, Pulmonary Hypertension Due to Lung Diseases and Hypoxia, Extreme Prematurity, Ventilator Lung; Newborn, Ventilation Perfusion Mismatch

About this study

In preterm infants \< 34 weeks' gestation at birth receiving respiratory support with invasive positive pressure ventilation, the positive end-expiratory pressure (PEEP) of best compliance will increase the cardiac output and improve oxygenation. This study may emphasize using point-of-care echocardiography along with electrical impedance tomography (EIT) to optimize ventilator settings in preterm infants. Infants will be randomized to a 4-hour crossover period of increasing and decreasing PEEP in random order from baseline to determine compliance, oxygenation, and cardiac hemodynamics at each step using echocardiography (ECHO) and EIT measurements. There will be a 15-minute washout period after changes prior to data collection.

Interventions

• Other: Increase in the PEEP followed by decrease in the PEEP — Changes in the ventilator PEEP and its effect on lung and cardiac hemodynamics
• Other: Decrease in the PEEP followed by increase in the PEEP — Changes in the ventilator PEEP and its effect on lung and cardiac hemodynamics

Primary outcomes

• Change in cardiac index with increase/decrease in PEEP as measured by ECHO and EIT (During a 4 hour cross-over period on either intervention)
• PEEP of best compliance and best oxygenation as per EIT measurements (During a 4 hour cross-over period on either intervention)

Eligibility information

Study locations

• Univerisity of Alabama, Birmingham, Alabama 35233 United States