The following is the summary of “Regular lung recruitment maneuvers during high-frequency oscillatory ventilation in extremely preterm infants: a randomized controlled trial” published in the January 2023 issue of Pediatrics by Werther, et al.

It is unknown when to repeat lung recruitment maneuvers (LRMs) after the initial increase in lung volume during high-frequency oscillatory ventilation (HFOV). Therefore, researchers analyzed how well-planned LRMs worked.  LRMs were given to severely premature infants on HFOV at 12-hour intervals and when clinically indicated (intervention) or just when clinically indicated (control) in a randomized controlled experiment (control). The primary endpoint was the oxygen saturation index (OSI) over 7 days of HFOV. In addition, LRMs were investigated to see if they contributed to an increase in OSI.

All told, there were thirty infants split into three groups of 15. At the beginning of HFOV, the intervention group had an average (SD) postmenstrual age of 23 weeks, 6 days, and a weight of 650 grams (115 ounces), while the control group had an average (SD) postmenstrual age of 24 weeks, 4 days, and a weight of 615 grams (95 ounces). The cumulative OSI for the intervention group was 4.95 (1.72), while it was 5.30 (2.08) for the control group (P=0.61). 

The intervention group had a higher mean (SD) number of LRMs (1.3 [0.2]) in 12 hours compared to the control group (1.1 [0.5]) (P=0.13). With FiO2>0.6, the average OSI drop from LRM was 3.6.2. There was no difference in lung volume between preterm infants who underwent regular versus clinically warranted LRMs during HFOV. High FiO2 is optimal for LRMs.