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Dynamic PEEP Study: A Non-invasive Diagnostic Exam to Assess for Effective PEEP in Children with Severe BPD

  • BRONCHOPULMONARY DYSPLASIA
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Abstract

Objective

Tracheobronchomalacia (TBM) is common in neonates with bronchopulmonary dysplasia (BPD) and is associated with higher morbidity. This study evaluates the value of a CT protocol to assess the degree of TBM and gauge the adequacy of prescribed PEEP.

Study Design

Four infants with severe BPD on invasive mechanical ventilation underwent a chest CT protocol, including limited reduced-dose expiratory scans with varying PEEP levels.

Results

Baseline PEEP was adjusted in all subjects after performing the Dynamic PEEP CT. In two infants, the PEEP was increased due to significant TBM and in the other two without signs of TBM PEEP was decreased. The clinical course improved in all patients after adjusting PEEP.

Conclusion

A “Dynamic PEEP” study may be reliable and non-invasive imaging modality for the evaluation of adequate ventilator settings in infants with severe BPD who are not optimal candidates for bronchoscopy.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

PEEP:

Positive end-expiratory pressure

FRC:

Functional residual capacity

NICU:

Neonatal intensive care unit

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA

    Cassie Montoya

  2. Division of Neonatology, Children’s National Medical Center, George Washington University, Washington, DC, USA

    Robin Steinhorn & Mariam Said

  3. Division of Cardiology, Children’s National Medical Center, George Washington University, Washington, DC, USA

    John Berger

  4. Division of Radiology, Children’s National Medical Center, George Washington University, Washington, DC, USA

    Harutyun Haroyan

  5. Division of Pulmonary and Sleep Medicine, Oishei Children’s Hospital, Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, Buffalo, NY, 14203, USA

    Geovanny F. Perez

Authors
  1. Cassie Montoya
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  2. Robin Steinhorn
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  3. John Berger
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  4. Harutyun Haroyan
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  5. Mariam Said
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  6. Geovanny F. Perez
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Contributions

CS, RS, JB, HH, MS, and GFP contributed to the design and implementation of the research, to the analysis of the results, and to the writing of the manuscript.

Corresponding author

Correspondence to Geovanny F. Perez.

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The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Montoya, C., Steinhorn, R., Berger, J. et al. Dynamic PEEP Study: A Non-invasive Diagnostic Exam to Assess for Effective PEEP in Children with Severe BPD. Lung 200, 59–65 (2022). https://doi.org/10.1007/s00408-021-00497-9

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  • DOI: https://doi.org/10.1007/s00408-021-00497-9

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