Forced oscillation technique for optimising peep in ventilated extremely preterm infants

We have found that the optimal PEEP during mechanical ventilation of extremely preterm infants, as evaluated by FOT in the first week of life, is lower than the clinically set PEEP and that it changes over time. The lower PEEPFOT identified on day 1 compared to day 3 and 7, together with the low FiO2 and PIP, suggests that the surfactant treated lungs of extremely preterm infants can be easily overdistended even at low PEEP. FOT might be a valuable bedside tool for assessment of lung mechanics for adjustments of PEEP over time and as part of a protective ventilation strategy to these vulnerable patients, especially during the first days of life. Further studies are needed to evaluate the possible long-term benefits of adjusting clinical PEEP by FOT, in this population of the most preterm infants.