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Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: A feasibility study.
MedLine Citation:
PMID:  23255291     Owner:  NLM     Status:  Publisher    
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 (C(dyn) ) 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 PaO(2) /FIO(2) 117 (96-139), and median C(dyn) 0.48 (0.41-0.68) ml/cmH(2) O/kg at baseline. Thirty RM were performed, with all completed successfully. No airleaks developed. Mild hypotension was detected during four procedures. Following RM, C(dyn) , and PaO(2) /FIO(2) increased significantly (P < 0.01 each), without changes in PaCO(2) (P = 0.4). A >25% improvement in lung function (C(dyn) or PaO(2) /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. © 2012 Wiley Periodicals, Inc.
Pablo Cruces; Alejandro Donoso; Jorge Valenzuela; Franco Díaz
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-19
Journal Detail:
Title:  Pediatric pulmonology     Volume:  -     ISSN:  1099-0496     ISO Abbreviation:  Pediatr. Pulmonol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510590     Medline TA:  Pediatr Pulmonol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
Área de Cuidados Críticos, Hospital Padre Hurtado, Santiago, Chile; Department of Pediatrics, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
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