Positive end-expiratory pressure improves elastic working pressure in anesthetized children

Pablo Cruces, Sebastián González-Dambrauskas, Federico Cristiani, Javier Martínez, Ronnie Henderson, Benjamin Erranz, Franco Díaz

Resultado de la investigación: Article

Resumen

Background: Positive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children. Methods: Patients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman's analysis were used. Significance was set at P < 0.05. Results: We included 30 patients, median age 39 (15-61.3) months old, 60% male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg- 1·cmH2O- 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min- 1 (all P < 0.01). There were no significant changes in resistance and QI. Conclusions: Analysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.

Idioma originalEnglish
Número de artículo151
PublicaciónBMC Anesthesiology
Volumen18
N.º1
DOI
EstadoPublished - 24 oct 2018

Huella dactilar

Positive-Pressure Respiration
Pressure
Respiratory Mechanics
Artificial Respiration
Lung Injury
Respiratory System
Ventilator-Induced Lung Injury
Mechanics
Informed Consent
Respiratory Insufficiency
General Anesthesia
Compliance
Lung
Wounds and Injuries

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Citar esto

Cruces, P., González-Dambrauskas, S., Cristiani, F., Martínez, J., Henderson, R., Erranz, B., & Díaz, F. (2018). Positive end-expiratory pressure improves elastic working pressure in anesthetized children. BMC Anesthesiology, 18(1), [151]. https://doi.org/10.1186/s12871-018-0611-8
Cruces, Pablo ; González-Dambrauskas, Sebastián ; Cristiani, Federico ; Martínez, Javier ; Henderson, Ronnie ; Erranz, Benjamin ; Díaz, Franco. / Positive end-expiratory pressure improves elastic working pressure in anesthetized children. En: BMC Anesthesiology. 2018 ; Vol. 18, N.º 1.
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abstract = "Background: Positive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children. Methods: Patients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman's analysis were used. Significance was set at P < 0.05. Results: We included 30 patients, median age 39 (15-61.3) months old, 60{\%} male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg- 1·cmH2O- 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min- 1 (all P < 0.01). There were no significant changes in resistance and QI. Conclusions: Analysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.",
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Cruces, P, González-Dambrauskas, S, Cristiani, F, Martínez, J, Henderson, R, Erranz, B & Díaz, F 2018, 'Positive end-expiratory pressure improves elastic working pressure in anesthetized children', BMC Anesthesiology, vol. 18, n.º 1, 151. https://doi.org/10.1186/s12871-018-0611-8

Positive end-expiratory pressure improves elastic working pressure in anesthetized children. / Cruces, Pablo; González-Dambrauskas, Sebastián; Cristiani, Federico; Martínez, Javier; Henderson, Ronnie; Erranz, Benjamin; Díaz, Franco.

En: BMC Anesthesiology, Vol. 18, N.º 1, 151, 24.10.2018.

Resultado de la investigación: Article

TY - JOUR

T1 - Positive end-expiratory pressure improves elastic working pressure in anesthetized children

AU - Cruces, Pablo

AU - González-Dambrauskas, Sebastián

AU - Cristiani, Federico

AU - Martínez, Javier

AU - Henderson, Ronnie

AU - Erranz, Benjamin

AU - Díaz, Franco

PY - 2018/10/24

Y1 - 2018/10/24

N2 - Background: Positive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children. Methods: Patients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman's analysis were used. Significance was set at P < 0.05. Results: We included 30 patients, median age 39 (15-61.3) months old, 60% male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg- 1·cmH2O- 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min- 1 (all P < 0.01). There were no significant changes in resistance and QI. Conclusions: Analysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.

AB - Background: Positive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children. Methods: Patients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman's analysis were used. Significance was set at P < 0.05. Results: We included 30 patients, median age 39 (15-61.3) months old, 60% male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg- 1·cmH2O- 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min- 1 (all P < 0.01). There were no significant changes in resistance and QI. Conclusions: Analysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.

KW - Mechanical ventilation

KW - Pediatrics

KW - Positive end-expiratory pressure

KW - Respiratory mechanics

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U2 - 10.1186/s12871-018-0611-8

DO - 10.1186/s12871-018-0611-8

M3 - Article

VL - 18

JO - BMC Anesthesiology

JF - BMC Anesthesiology

SN - 1471-2253

IS - 1

M1 - 151

ER -

Cruces P, González-Dambrauskas S, Cristiani F, Martínez J, Henderson R, Erranz B y otros. Positive end-expiratory pressure improves elastic working pressure in anesthetized children. BMC Anesthesiology. 2018 oct 24;18(1). 151. https://doi.org/10.1186/s12871-018-0611-8