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

• DOI: 10.1007/s00408-021-00497-9
• Publication Date: 2022-01-11T00:03:06Z
• Authors: Cassie Montoya; Robin Steinhorn; John Berger; Harutyun Haroyan; Mariam Said; Geovanny F. Perez
• Keywords: Tracheobronchomalacia; 03 medical and health sciences; Ventilators, Mechanical; 0302 clinical medicine; Bronchoscopy; Infant, Newborn; Humans; Infant; Child; Respiration, Artificial; Bronchopulmonary Dysplasia

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