Document Detail

Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end-expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease.
MedLine Citation:
PMID:  19863733     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Optimizing alveolar recruitment by alveolar recruitment strategy (ARS) and maintaining lung volume with adequate positive end-expiratory pressure (PEEP) allow preventing ventilator-induced lung injury (VILI). Knowing that PEEP has its most beneficial effects when dynamic compliance of respiratory system (Crs) is maximized, we hypothesize that the use of 8 cm H(2)O PEEP with ARS results in an increase in Crs and end-expiratory lung volume (EELV) compared to 8 cm H(2)O PEEP without ARS and to zero PEEP in pediatric patients undergoing cardiac surgery for congenital heart disease. METHODS: Twenty consecutive children were studied. Three different ventilation strategies were applied to each patient in the following order: 0 cm H(2)O PEEP, 8 cm H(2)O PEEP without an ARS, and 8 cm H(2)O PEEP with a standardized ARS. At the end of each ventilation strategy, Crs, EELV, and arterial blood gases were measured. RESULTS: EELV, Crs, and P(a)O(2)/FiO(2) ratio changed significantly (P < 0.001) with the application of 8 cm H2O + ARS. Mean P(a)CO(2)- PETCO(2) difference between 0 PEEP and 8 cm H2O PEEP + ARS was also significant (P < 0.05). CONCLUSION: An alveolar recruitment strategy with relative high PEEP significantly improves Crs, oxygenation, P(a)CO(2)- PETCO(2) difference, and EELV in pediatric patients undergoing cardiac surgery for congenital heart disease.
Thierry V Scohy; Ido G Bikker; Jan Hofland; Peter L de Jong; Ad J J C Bogers; Diederik Gommers
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Publication Detail:
Type:  Journal Article     Date:  2009-10-23
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  19     ISSN:  1460-9592     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-18     Completed Date:  2010-03-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  1207-12     Citation Subset:  IM    
Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Child, Preschool
Heart Defects, Congenital / surgery*
Lung Compliance*
Lung Injury / prevention & control
Lung Volume Measurements / methods
Oxygen / blood
Positive-Pressure Respiration / methods
Pulmonary Alveoli / physiology*
Pulmonary Gas Exchange*
Pulmonary Ventilation*
Respiration, Artificial / methods*
Treatment Outcome
Reg. No./Substance:

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