Lung Protective Strategies of Ventilation for the Preterm Infants with Pulmonary Hemorrhage

Objective To study the effect of lung protective strategies of ventilation on the preterm infants with pulmonary hemorrhage.Method Fifty-two preterm infants with pulmonary hemorrhage were randomly divided into two groups:lung protective ventilation group(LPV,n=23) and conventional mechanical ventilation group(CMV,n=29).The parameters of ventilation,results of blood-gas analysis,incidences of ventilator associated lung injury,intraventricular hemorrhage(IVH),patent ductus arteriosus(PDA),and mortality were compared.Result In the peak stage of pulmonary hemorrhage,peak inflation pressure(PIP),mean airway pressure(MAP),positive end-expiratory pressure(PEEP) and inspiratory time(Ti) were(25.1±2.2)cmH2O,(10.2±2.4)cmH2O,(6.2±0.7)cmH2O and(0.53±0.1)s,respectively in the LPV group.All significantly lower than those in the CMV group(29.3±2.6)cmH2O,(13.3±2.7)cmH2O,(6.9±0.7)cmH2O and(0.69±0.1)s,respectively,P 0.01.There were no differences in infraction of inspired oxygen(FiO2) and ventilation rate(VR) between the two groups(P 0.05).The pH(7.30±0.08) in the LPV group was lower than that in the CMV group(7.35±0.08),P 0.01,but PaCO2(45±6)mmHg was higher than that in the CMV group(40±7)mmHg,P 0.01.The PaO2,SaO2,RR and BP of the LPV group showed no difference from those of the CMV group.The LPV group had lower incidence of VALI(10.3% vs 34.8%,P 0.05) and similar incidences of IVH and PDA to those of the CMV group.LPV resulted in a decreased mortality compared with CMV [10.3%(3/29) vs 39.1%(9/23),P 0.05].Conclusion Using lung protective strategies of ventilation can significantly reduce the incidence of VALI and the mortality for preterm infants with pulmonary hemorrhage.