{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:00:41Z","timestamp":1790517641924,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T00:00:00Z","timestamp":1554336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>Infants with severe bronchopulmonary dysplasia (sBPD) and airway obstruction may develop dynamic hyperinflation and intrinsic positive end\u2010expiratory pressure (PEEP<jats:sub>i<\/jats:sub>), which impairs patient\/ventilator synchrony.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine if PEEP<jats:sub>i<\/jats:sub> is present in infants with sBPD during spontaneous breathing and if adjusting ventilator PEEP improves patient\/ventilator synchrony and comfort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Interventional study in infants with sBPD. PEEP<jats:sub>i<\/jats:sub> measured by esophageal pressure (Pes) and pneumotachometer, during pressure\u2010supported breaths. PEEP\n<jats:sub>i<\/jats:sub> defined as the difference between Pes at start of the inspiratory effort minus Pes at onset of inspiratory flow. The set PEEP was adjusted to minimize PEEP\n<jats:sub>i<\/jats:sub>. \u201cBest PEEP\u201d was the setting with minimal wasted efforts (WE), an inspiratory effort seen on the Pes waveform without a corresponding ventilator breath. FiO\n<jats:sub>2<\/jats:sub> and SpO\n<jats:sub>2<\/jats:sub> measured pre\u2010 and post\u2010PEEP adjustment. Sedation requirements evaluated 72\u2009hours preprocedure and postprocedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve infants were assessed (gestational age, 24.9\u2009\u00b1\u20091.4 weeks; study age, 48.8\u2009\u00b1\u20091.5 weeks, postmenstrual age). Mean baseline ventilator PEEP was 16.4\u2009cm\u2009H<jats:sub>2<\/jats:sub>O (14\u201020\u2009cm\u2009H\n<jats:sub>2<\/jats:sub>O). Eight infants required an increase, one, a reduction, and three, no change in the set PEEP. For the eight infants requiring an increase in set PEEP, there was an 18.9% reduction in WE and a reduction in FiO\n<jats:sub>2<\/jats:sub> (0.084\n<jats:styled-content>\u2009<\/jats:styled-content>\u00b1\n<jats:styled-content>\u2009<\/jats:styled-content>0.058) requirements in the subsequent 24\u2009hours. Conditional sedation was reduced in five infants postprocedure. No adverse events occurred during testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PEEP<jats:sub>i<\/jats:sub> is measurable in infants with sBPD with concurrent esophageal manometry and flow\u2010time tracings without the need for pharmacological paralysis. In those with PEEP\n<jats:sub>i<\/jats:sub>, increasing ventilator PEEP to offset PEEP\n<jats:sub>i<\/jats:sub> improves synchrony.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.24328","type":"journal-article","created":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T19:07:40Z","timestamp":1554491260000},"page":"1045-1051","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia"],"prefix":"10.1002","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1498-8465","authenticated-orcid":false,"given":"Natalie","family":"Napolitano","sequence":"first","affiliation":[{"name":"Department of Respiratory Therapy Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khair","family":"Jalal","sequence":"additional","affiliation":[{"name":"Division of Neonatology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"McDonough","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy Children's Hospital of Philadelphia Philadelphia Pennsylvania"},{"name":"Division of Pulmonary Medicine Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather M.","family":"Monk","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0843-8448","authenticated-orcid":false,"given":"Huayan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Neonatology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Jensen","sequence":"additional","affiliation":[{"name":"Division of Neonatology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Dysart","sequence":"additional","affiliation":[{"name":"Division of Neonatology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haresh M.","family":"Kirpalani","sequence":"additional","affiliation":[{"name":"Division of Neonatology Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard B.","family":"Panitch","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine Children's Hospital of Philadelphia Philadelphia 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