Individualized lung recruitment during high-frequency ventilation in preterm infants is not associated with lung hyperinflation and air leaks

Lung recruitment during high-frequency ventilation (HFV) in preterm infants with respiratory distress syndrome (RDS) has been associated with an increased risk of lung hyperinflation and air leaks. Individualizing the lung recruitment procedure to the severity of lung disease of each patient might reduce these risks. In this prospective cohort study, we evaluated chest X-ray (CXR) characteristics during individualized oxygenation-guided lung recruitment with HFV in preterm infants with RDS, before and after surfactant therapy. Two pediatric radiologists scored radiolucency, the presence of lung hyperinflation, and/or air leaks following lung recruitment during HFV in 69 infants before and 39 infants after surfactant treatment. Following lung recruitment, the median radiolucency score was 2, with 44 (64 %) infants having a score ≤2. Only mild to moderate hyperinflation was seen in 13 (19 %) infants, with no air leaks. After the surfactant, the radiolucency score improved in 62 % of 39 paired CXRs (p < 0.001). Mild to moderate hyperinflation was seen in nine (24 %) patients. During the entire admission, only four (6 %) of the patients developed air leaks. Conclusion: The risk of significant hyperinflation and air leaks is low when using an individualized oxygenation-guided recruitment procedure during HFV in preterm infants with RDS.What is Known:• Lung recruitment during high-frequency ventilation in preterm infants with respiratory distress syndrome is associated with an increased risk of lung hyperinflation and air leaks.What is New:• The risk of lung hyperinflation and air leaks is low when using an individualized oxygenation-guided lung recruitment procedure during high-frequency ventilation in preterm infants with respiratory distress syndrome.