Affiliations: [a] Neonatal and Paediatric Intensive Care Unit, M. Bufalini Hospital, AUSL Romagna, Cesena, Italy
| [b] Department of Mother’s and Child’s Health, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| [c] Dipartimento Universitario Scienze della Vita e Sanitá Pubblica, Unitá Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Universitá Cattolica del Sacro Cuore, Rome, Italy
| [d] Department of Pediatrics, ASST Vimercate, Vimercate Hospital, Vimercate, Italy
| [e] Department of Critical Care, Ospedale Maggiore di Cremona, Cremona, Italy
| [f] Emergency Department, Latisana General Hospital, Udine, Italy
Correspondence:
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Address for correspondence: Maria Pierro, Neonatal and Paediatric Intensive Care Unit, M. Bufalini Hospital, AUSL Romagna, Viale G. Ghirotti, 286 - 47521, Cesena, Italy. E-mail: [email protected].
Abstract: BACKGROUND:Recently, the first report of lung ultrasound (LUS) guided recruitment during open lung ventilation in neonates has been published. LUS guided recruitment can change the approach to open lung ventilation, which is currently performed without any measure of lung function/lung expansion in the neonatal population. METHODS:We included all the newborn infants that underwent a LUS-guided recruitment maneuver during mechanical ventilation as a rescue attempt for an extremely severe respiratory condition with oxygen saturation/fraction of inspired oxygen (SpO2/FIO2) ratio below 130 or the inability to wean off mechanical ventilation. RESULTS:We report a case series describing 4 LUS guided recruitment maneuvers, underlying crucial aspects of this technique that can improve the effectiveness of the procedure. In particular, we describe a novel pattern (the S-pattern) that allows us to distinguish the recruitable from the unrecruitable lung and guide the pressure titration phase. Additionally, we describe the optimal LUS-guided patient positioning. CONCLUSIONS:We believe that the inclusion of specifications regarding patient positioning and the S-pattern in the LUS-guided protocol may be beneficial for the success of the procedure.
