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.
Post-natal age > 7 days and less than 1 month (outside golden week protocol)
Gestational age ≥ 21 weeks and ≤ 34 week
Infants with written informed consent obtained from legal guardian
Blood culture-positive sepsis
Congenital anomalies affecting respiration
Cyanotic or ductal-dependent congenital heart disease
Newborns who are considered too unstable for study enrolment per neonatology attending
Crossover
Increase in the PEEP followed by decrease in the PEEP
Other interventionChanges in the ventilator PEEP and its effect on lung and cardiac hemodynamics
Decrease in the PEEP followed by increase in the PEEP
Other interventionChanges in the ventilator PEEP and its effect on lung and cardiac hemodynamics
Change in cardiac index with increase/decrease in PEEP as measured by ECHO and EIT
PEEP of best compliance and best oxygenation as per EIT measurements
Tidal volume variation
Oxygen saturation index
End-expiratory lung impedance (EELI), End-inspiratory lung impedance (EILI)
Transcutaneous carbon dioxide (TcCO2) values in response to varying PEEP levels
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