Lung recruitment in neonatal high‐frequency oscillatory ventilation with volume‐guarantee

Background and Objectives The optimal lung volume strategy during high‐frequency oscillatory ventilation (HFOV) is reached by performing recruitment maneuvers, usually guided by the response in oxygenation. In animal models, secondary spontaneous change in oscillation pressure amplitude (ΔPhf) associated with a progressive increase in mean airway pressure during HFOV combined with volume guarantee (HFOV‐VG) identifies optimal lung recruitment. The aim of this study was to describe recruitment maneuvers in HFOV‐VG and analyze whether changes in ΔPhf might be an early predictor for lung recruitment in newborn infants with severe respiratory failure. Design and Methods The prospective observational study was done in a tertiary‐level neonatology department. Changes in ΔPhf were analyzed during standardized lung recruitment after initiating early rescue HFOV‐VG in preterm infants with severe respiratory failure. Results Twenty‐seven patients were included, with a median gestational age of 24 weeks (interquartile range [IQR]: 23–25). Recruitment maneuvers were performed, median baseline mean airway pressure (mPaw) was 11 cm H2O (IQR: 10–13), median critical lung opening mPaw during recruitment was 14 cm H2O (IRQ: 12–16), and median optimal mPaw was 12 cm H2O (IQR: 10–14, p