According to my knowledge, if I have a case with PIE and I would like to use a conventional ventilator, I would use a low PEEP.  Does anyone have an article which mentions that?

In addition, can anyone let me know the settings they use on conventional ventilation for PIEs, using both with volume guaranteed and without? 

Thanks

 

 

 

Sorry I cannot share anything valuable about this

Have only experience from low-volume strategy on HFO only (but have good experience with HFO for any air leaks incl PIE)

On conventional ventilators, a higher PEEP is recommended to stint the airways open but a lower volume guarantee and a higher rate with a small Ti. 

@mosarrat that strategy makes sense, to maintain alveolar expansion but without over-stretching. What typical PEEP do you apply, what tidal volume/kg do you aim (or is usually possible?) at and how low do you go with Ti?

HFOV would be ideal but for conventional ventilation, fast rate, short inspiratory time and low pressures would be the ideal strategy along with lateral decubitus positioning and/or selective bronchial intubation if unilateral. The details lof thje clonventional styrategy are in Keszler M, et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991;119:85-93.

@chandas Thanks a lot for sharing the article Keszler M, et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991;119:85-93. It's a very conclusive article.    The study used low PEEPs ( > 5 cm H2O), high resp. rates 60~100 BPM, low Tis 0.2 ~ 0.35 sec, and PIP guided by adequate chest wall movement and gas exchange. Lower pressures were targeted even at the cost of higher FIO2. It's clear, however, unfortunately, the authors didn't show how low did they go on the PEEPs and what was/were the indicator/s for how low they can go on PEEPs. Did they use PEEPs of 1 or 2 cm H2O and would that make any difference?         We had a discussion in the NICU and it is hard to convince the team with PEEPs below 4 cm H2O. 

@mosarrat & @Stefan Johansson

Thank you for your comments, really appreciated.  

I am attaching the article Keszler M, et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991;119:85-93. I marked the site of CMV ventilatory settings.

If you have an article which supports higher PEEPs in PIEs, I would really appreciate if you could share it with me, as both high PEEP and low PEEP were challenged in our unit`s discussion.

Lower PEEP in CMV for PIE.pdf

In all of our PIE Cases HFO With Low Volume strategy (HFO Peep = Mean Airways pressure of  conventional Ventilation minus 1) were Superior. We never achieved any comparable effects in any CMV setting. We tried a lot. And: we often See onesided PIE: so dont forget to lay PIEside downward.