A non-invasive diagnostic tool for the assessment of optimal positive-end expiratory pressure (PEEP_OPT) in infants receiving prolonged invasive ventilation

Objective: Establish the feasibility of optimizing PEEP (PEEP_OPT) using ventilator software in infants receiving prolonged invasive mechanical ventilation. Methods: A retrospective review of infants who underwent PEEP_OPT studies. Paired-t test was used to compare dynamic lung compliance (Cdyn), tidal volume (VT), and oxygen saturation (SpO₂) before and after PEEP_OPT studies. Results: Fifteen infants with bronchopulmonary dysplasia and/or receiving prolonged invasive mechanical ventilation were included with a median gestational age of 24 4/7 weeks and postmenstrual age of 40 1/7 weeks at the time of the PEEP_OPT study. PEEP_OPT was different from clinically set PEEP (PEEP_SET) in 14/15 infants; PEEP_OPT was higher in 27% and lower in 67% of infants (–2 to +5cmH₂O). Cdyn improved for most infants by 0.23 (0.01–0.60) mL/H₂O (p < 0.001). VT increased for most infants by 1.5 (–0.5 to 3.4) mL/kg (p < 0.001), and SpO₂ increased by 2% (–1 to 12%). Conclusion: Assessment of PEEP_OPT using our standardized protocol is feasible, non-invasive, and provides a low-cost bedside tool. PEEP_OPT differed from PEEP_SET in most subjects, highlighting the importance of evaluating PEEP_OPT.