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Comparison of Two Lung Recruitment Strategies in Children with Acute Lung.
MedLine Citation:
PMID:  23232733     Owner:  NLM     Status:  Publisher    
BACKGROUND. Lung recruitment maneuvers are frequently used in the treatment of children with lung injury. Here, we describe a pilot study to compare the acute effects of two commonly used lung recruitment maneuvers on lung volume, gas exchange and hemodynamic profiles in children with acute lung injury (ALI). METHODS. In a prospective, non-randomized, cross-over pilot study, n=10 intubated pediatric patients with lung injury sequentially underwent (1) a period of observation, (2) a sustained inflation (SI) maneuver of 40 cm H(2)O for 40 seconds and open lung ventilation, (3) a staircase recruitment strategy (SRS) which utilized 5 cm H(2)O increments in airway pressure from a starting plateau pressure of 30 cm H(2)O and PEEP of 15 cm H(2)O, (4) a downwards PEEP titration and (5) a one hour period of observation with PEEP set 2 cm H(2)O above closing PEEP. RESULTS. Arterial blood gases, lung mechanics, hemodynamics and functional residual capacity were recorded following each phase of the study and following each increment of the SRS. Both SI and SRS were effective in raising arterial oxygen tension and functional residual capacity. During the SRS maneuver, we noted significant increases in dead space ventilation, a decrease in CO(2) elimination, an increase in arterial carbon dioxide tension and a decrease in compliance of the respiratory system (Crs). Lung recruitment was not sustained following the decremental PEEP titration. CONCLUSIONS. SRS is effective in opening the lung in children with early ALI, and is hemodynamically well tolerated. However, attention must be paid to carbon dioxide tension during the SRS. Even minutes following lung recruitment, lungs may derecruit when PEEP is lowered beyond the closing pressure.
John N Kheir; Brian K Walsh; Craig D Smallwood; Jordan S Rettig; John E Thompson; Camille Gómez-Laberge; Gerhard K Wolf; John H Arnold
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-4
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Cardiology (JNK), Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine (JNK, JSR, CGL, GKW, JHA) and the Department of Respiratory Care (BKW, CDS, JET) at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Respiratory Care, Children's Medical Center, Dallas, Texas (BKW).
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