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

Authors

Cassie Montoya, 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.
Robin Steinhorn, Division of Neonatology, Children's National Medical Center, George Washington University, Washington, DC, USA.
John Berger, Division of Cardiology, Children's National Medical Center, George Washington University, Washington, DC, USA.
Harutyun Haroyan, Division of Radiology, Children's National Medical Center, George Washington University, Washington, DC, USA.
Mariam Said, Division of Neonatology, Children's National Medical Center, George Washington University, Washington, DC, USA.
Geovanny F. Perez, Division of Pulmonary and Sleep Medicine, Oishei Children's Hospital, Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, Buffalo, NY, 14203, USA. gperez9@buffalo.edu.

Document Type

Journal Article

Publication Date

2-1-2022

Journal

Lung

Volume

200

Issue

1

DOI

10.1007/s00408-021-00497-9

Keywords

Bronchopulmonary dysplasia; PEEP; Pulmonary hypertension; Pulmonary vein stenosis; Tracheomalacia

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.

APA Citation

Montoya, Cassie; Steinhorn, Robin; Berger, John; Haroyan, Harutyun; Said, Mariam; and Perez, Geovanny F., "Dynamic PEEP Study: A Non-invasive Diagnostic Exam to Assess for Effective PEEP in Children with Severe BPD" (2022). GW Authored Works. Paper 379.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/379

Department

Pediatrics