Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study

Pablo Cruces, Alejandro Donoso, Jorge Valenzuela, Franco Díaz

Resultado de la investigación: Article

11 Citas (Scopus)

Resumen

Background Little is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. Methods We enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72 hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (Cdyn) and gas exchange 1, 12, and 24 hr after the RM. Results We included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2) kg, median PaO2/FIO2 117 (96-139), and median Cdyn 0.48 (0.41-0.68) ml/cmH2O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, Cdyn, and PaO2/FIO2 increased significantly (P < 0.01 each), without changes in PaCO2 (P = 0.4). A >25% improvement in lung function (Cdyn or PaO2/FIO 2) was observed after 90% of the RM procedures. Gas exchange worsening over the next 24 hr resulted in HFOV use in 36% of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24 hr. The 28-day mortality rate was 16%. Conclusions Sequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia. Pediatr Pulmonol. 2013; 48:1135-1143.

Idioma originalEnglish
Páginas (desde-hasta)1135-1143
Número de páginas9
PublicaciónPediatric Pulmonology
Volumen48
N.º11
DOI
EstadoPublished - 2013

Huella dactilar

Adult Respiratory Distress Syndrome
Feasibility Studies
Hemodynamics
Pediatrics
Lung
Positive-Pressure Respiration
Gases
Mechanics
Safety
Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)
  • Pulmonary and Respiratory Medicine

Citar esto

Cruces, Pablo ; Donoso, Alejandro ; Valenzuela, Jorge ; Díaz, Franco. / Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS : A feasibility study. En: Pediatric Pulmonology. 2013 ; Vol. 48, N.º 11. pp. 1135-1143.
@article{fceb5b116de74a598f439c3af9c3c82d,
title = "Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study",
abstract = "Background Little is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. Methods We enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72 hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (Cdyn) and gas exchange 1, 12, and 24 hr after the RM. Results We included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2) kg, median PaO2/FIO2 117 (96-139), and median Cdyn 0.48 (0.41-0.68) ml/cmH2O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, Cdyn, and PaO2/FIO2 increased significantly (P < 0.01 each), without changes in PaCO2 (P = 0.4). A >25{\%} improvement in lung function (Cdyn or PaO2/FIO 2) was observed after 90{\%} of the RM procedures. Gas exchange worsening over the next 24 hr resulted in HFOV use in 36{\%} of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24 hr. The 28-day mortality rate was 16{\%}. Conclusions Sequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia. Pediatr Pulmonol. 2013; 48:1135-1143.",
keywords = "acute respiratory distress syndrome, hemodynamic, hypoxemia, pediatrics, recruitment",
author = "Pablo Cruces and Alejandro Donoso and Jorge Valenzuela and Franco D{\'i}az",
year = "2013",
doi = "10.1002/ppul.22729",
language = "English",
volume = "48",
pages = "1135--1143",
journal = "Pediatric Pulmonology",
issn = "8755-6863",
publisher = "Wiley-Liss Inc.",
number = "11",

}

Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS : A feasibility study. / Cruces, Pablo; Donoso, Alejandro; Valenzuela, Jorge; Díaz, Franco.

En: Pediatric Pulmonology, Vol. 48, N.º 11, 2013, p. 1135-1143.

Resultado de la investigación: Article

TY - JOUR

T1 - Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS

T2 - A feasibility study

AU - Cruces, Pablo

AU - Donoso, Alejandro

AU - Valenzuela, Jorge

AU - Díaz, Franco

PY - 2013

Y1 - 2013

N2 - Background Little is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. Methods We enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72 hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (Cdyn) and gas exchange 1, 12, and 24 hr after the RM. Results We included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2) kg, median PaO2/FIO2 117 (96-139), and median Cdyn 0.48 (0.41-0.68) ml/cmH2O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, Cdyn, and PaO2/FIO2 increased significantly (P < 0.01 each), without changes in PaCO2 (P = 0.4). A >25% improvement in lung function (Cdyn or PaO2/FIO 2) was observed after 90% of the RM procedures. Gas exchange worsening over the next 24 hr resulted in HFOV use in 36% of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24 hr. The 28-day mortality rate was 16%. Conclusions Sequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia. Pediatr Pulmonol. 2013; 48:1135-1143.

AB - Background Little is known about the efficacy and safety of recruitment maneuvers (RMs) in pediatric patients with acute respiratory distress syndrome (ARDS). We therefore assessed the effects on gas exchange and lung mechanics and the possible detrimental effects of a sequential lung RMs and decremental positive end-expiratory pressure (PEEP) titration in pediatric ARDS patients. Methods We enrolled patients <15 years of age with ARDS, progressive hypoxemia, <72 hr of mechanical ventilation, and hemodynamic stability. A step-wise RM and decremental PEEP trial were performed. Safety was evaluated as the occurrence of hypotension and low pulse oxymeter oxygen saturation during the maneuver and development of airleaks after. Efficacy was evaluated as changes in lung compliance (Cdyn) and gas exchange 1, 12, and 24 hr after the RM. Results We included 25 patients, of median age 5 (1-16) months, median weight 7.0 (4.1-9.2) kg, median PaO2/FIO2 117 (96-139), and median Cdyn 0.48 (0.41-0.68) ml/cmH2O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, Cdyn, and PaO2/FIO2 increased significantly (P < 0.01 each), without changes in PaCO2 (P = 0.4). A >25% improvement in lung function (Cdyn or PaO2/FIO 2) was observed after 90% of the RM procedures. Gas exchange worsening over the next 24 hr resulted in HFOV use in 36% of patients, while the remaining subjects sustained improvements in oxygenation at 12 and 24 hr. The 28-day mortality rate was 16%. Conclusions Sequential RMs were safe and well tolerated in hemodynamically stable children with ARDS. RMs and a decremental PEEP trial may improve lung function in pediatric patients with ARDS and severe hypoxemia. Pediatr Pulmonol. 2013; 48:1135-1143.

KW - acute respiratory distress syndrome

KW - hemodynamic

KW - hypoxemia

KW - pediatrics

KW - recruitment

UR - http://www.scopus.com/inward/record.url?scp=84886425213&partnerID=8YFLogxK

U2 - 10.1002/ppul.22729

DO - 10.1002/ppul.22729

M3 - Article

C2 - 23255291

AN - SCOPUS:84886425213

VL - 48

SP - 1135

EP - 1143

JO - Pediatric Pulmonology

JF - Pediatric Pulmonology

SN - 8755-6863

IS - 11

ER -