Efficacy and safety of lung recruitment in pediatric patients with acute lung injury

被引：46
作者：
Boriosi, Juan P. [1 ]
Sapru, Anil [2 ]
Hanson, James H. [3 ]
Asselin, Jeanette [6 ]
Gildengorin, Ginny [4 ]
Newman, Vivienne [5 ]
Sabato, Katie [5 ]
Flori, Heidi R. [5 ]
机构：
[1] Univ Wisconsin, Dept Pediat, Madison, WI 53706 USA
[2] Univ Calif San Francisco, Dept Pediat, San Francisco, CA USA
[3] Kaiser Permanente Grp, Oakland, CA USA
[4] Childrens Hosp Oakland, Res Inst, Oakland, CA 94609 USA
[5] Childrens Hosp, Res Ctr, Oakland, CA 94609 USA
[6] Res Ctr, Oakland, CA USA
来源：
PEDIATRIC CRITICAL CARE MEDICINE | 2011年 / 12卷 / 04期
关键词：
ARDS; respiratory distress syndrome; adult; ALI; acute lung injury; positive end-expiratory pressure; pulmonary gas exchange; RESPIRATORY-DISTRESS-SYNDROME; END-EXPIRATORY PRESSURE; LOW TIDAL VOLUMES; ALVEOLAR RECRUITMENT; PERMISSIVE HYPERCAPNIA; PROTECTIVE-VENTILATION; INSPIRATORY PRESSURE; SUSTAINED INFLATION; LIMITED VENTILATION; GAS-EXCHANGE;
D O I：
10.1097/PCC.0b013e3181fe329d
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
Objective: To assess the safety and efficacy of a recruitment maneuver, the Open Lung Tool, in pediatric patients with acute lung injury and acute respiratory distress syndrome. Design: Prospective cohort study using a repeated-measures design. Setting: Pediatric intensive care unit at an urban tertiary children's hospital. Patients: Twenty-one ventilated pediatric patients with acute lung injury. Intervention: Recruitment maneuver using incremental positive end-expiratory pressure. Measurements and Main Results: The ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (PaO2/FIO2 ratio) increased 53% immediately after the recruitment maneuver. The median PaO2/FIO2 ratio increased from 111 (interquartile range, 73-266) prerecruitment maneuver to 170 (interquartile range, 102-341) immediately postrecruitment maneuver (p < .01). Improvement in PaO2/FIO2 ratio persisted with an increase of 80% over the baseline at 4 hrs and 40% at 12 hrs after the recruitment maneuver. The median PaO2/FIO2 ratio was 200 (interquartile range, 116-257) 4 hrs postrecruitment maneuver (p < .05) and 156 (interquartile range, 127-236) 12 hrs postrecruitment maneuver (p <. 01). Compared with prerecruitment maneuver, the partial pressure of arterial carbon dioxide (PaCO2) was significantly decreased at 4 hrs postrecruitment maneuver but not immediately after the recruitment maneuver. The median PaCO2 was 49 torr (interquartile range, 44-60) prerecruitment maneuver compared with 48 torr (interquartile range, 43-50) immediately postrecruitment maneuver (p = .69), 45 torr (interquartile range, 41-50) at 4 hrs postrecruitment maneuver (p < .01), and 43 torr (interquartile range, 38-51) at 12 hrs postrecruitment maneuver. Recruitment maneuvers were well tolerated except for significant increase in PaCO2 in three patients. There were no serious adverse events related to the recruitment maneuver. Conclusions: Using the modified open lung tool recruitment maneuver, pediatric patients with acute lung injury may safely achieve improved oxygenation and ventilation with these benefits potentially lasting up to 12 hrs postrecruitment
引用
收藏
页码：431 / 436
页数：6
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