Intratidal recruitment/derecruitment persists at low and moderate positive end-expiratory pressure in paediatric patients

被引：14

作者：

Wirth, Steffen ^{[1
]}

Artner, Lisa ^{[1
]}

Bross, Tobias ^{[1
]}

Lozano-Zahonero, Sara ^{[1
]}

Spaeth, Johannes ^{[1
]}

Schumann, Stefan ^{[1
]}

机构：

[1] Univ Freiberg, Dept Anesthesiol & Crit Care, Fac Med, Med Ctr, Freiburg, Germany

来源：

RESPIRATORY PHYSIOLOGY & NEUROBIOLOGY | 2016年 / 234卷

关键词：

Mechanical ventilation; Lung compliance; Children; Functional residual capacity; Protective ventilation; Compliance-volume curve; Respiratory system mechanics; FUNCTIONAL RESIDUAL CAPACITY; RESPIRATORY SYSTEM MECHANICS; ABDOMINAL-SURGERY; VENTILATION HOMOGENEITY; ANESTHETIZED CHILDREN; PULMONARY COMPLICATIONS; NEUROMUSCULAR BLOCKADE; PRESCHOOL-CHILDREN; GENERAL-ANESTHESIA; DYNAMIC COMPLIANCE;

D O I：

10.1016/j.resp.2016.08.008

中图分类号：

Q4 [生理学];

学科分类号：

071003 ;

摘要：

In paediatric patients positive end-expiratory pressure (PEEP) is traditionally set lower than in adults. We investigated whether moderately higher PEEP improves respiratory mechanics and regional ventilation. Therefore, 40 children were mechanically ventilated with PEEP 2 and 5 cmH(2)O. Volume-dependent compliance profiles were analysed as a measure of intratidal recruitment/derecruitment. Regional ventilation was assessed using electrical impedance tomography. Mean compliance was 17.9 +/- 9.9 mLcmH(2)O(-1) (PEEP 2 cmH(2)O), and 19.0 +/- 10.9 mL cmH(2)O(-1) (PEEP 5 cmH(2)O, p < 0.001). Strong intratidal recruitment/derecruitment occurred in 40% of children at PEEP 2 cmH(2)O, and 36% at PEEP 5 cmH(2)O. Children showing strong recruitment/derecruitment were 33 (PEEP 2 cmH(2)O) and 20 (PEEP 5 cmH(2)O) months younger than children showing moderate recruitment/derecruitment. A higher PEEP improved peripheral ventilation. In conclusion, mechanically ventilated paediatric patients undergo intratidal recruitment/derecruitment which occurs more prominently in younger than in older children. A PEEP of 5 cmH(2)O does not fully prevent intratidal recruitment/derecruitment but homogenizes regional ventilation in comparison to 2 cmH(2)O. (C) 2016 Elsevier B.V. All rights reserved.

引用

页码：9 / 13

页数：5

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