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Distribution and pathophysiology of acute lobar collapse in the pediatric intensive care unit
1Department of Diagnostic Radiology, St. Mary's Hospital Medical School, London, UK.
Insights
Pediatric intensive care patients show a higher incidence of right upper lobe collapse compared to adults, often linked to mechanical ventilation and younger age. This contrasts with adult lower lobe collapse patterns, likely due to respiratory tract differences.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Radiology
Background:
- Lower lobe collapse is common in adult intensive care.
- Pediatric respiratory anatomy and physiology differ from adults.
- Understanding pediatric lobar collapse is crucial for effective management.
Purpose of the Study:
- To determine the incidence and distribution of acute lobar collapse in pediatric intensive care.
- To explore factors contributing to lobar collapse in children.
- To compare pediatric findings with adult intensive care data.
Main Methods:
- Retrospective review of chest radiograph series.
- Analysis of 160 pediatric intensive care patients over two years.
- Correlation of lobar collapse with patient age, ventilation status, and endotracheal tube position.
Main Results:
- 15% of pediatric patients (24/160) developed acute lobar collapse.
- Right upper lobe collapse was the most frequent type.
- Lobar collapse was associated with younger age and mechanical ventilation.
Conclusions:
- Pediatric intensive care patients exhibit a predominance of upper lobe collapse, particularly the right upper lobe.
- This contrasts with the higher incidence of lower lobe collapse in adults.
- Differences in anatomy, physiology, disease, and endotracheal tube management likely contribute to these findings.
Objective:
The high incidence of lower lobe collapse in adult intensive care patients is well described. We aimed to document the incidence and distribution of acute lobar collapse in the pediatric intensive care setting. The influence of anatomical and pathophysiological differences between the adult and pediatric respiratory tract will be considered.
Design:
Retrospective review of chest radiograph series.
Setting:
Tertiary referral center for pediatric intensive care and the Department of Diagnostic Radiology in a large teaching hospital in England.
Patients:
Cohort of 160 patients receiving intensive care during a 2-yr period (age range, 6 days-18 yrs; median, 23 months).
Interventions:
None
Measurements And Main Results:
Twenty-four of 160 children (15%) developed acute lobar collapse during their intensive care unit admission. Isolated right upper lobe collapse occurred in 14 patients, right upper lobe in association with one or more other lobes in five patients, and lobar collapse other than the right upper lobe in five patients. The development of lobar collapse and, in particular, right upper lobe collapse was associated with a lower median age (no collapse, 26 months; lobar collapse, 8 months; right upper lobe collapse, 4 months). Lobar collapse was significantly associated with the requirement for mechanical ventilation during admission (chi-square, 12.18; p = .005). It was observed in association with both high and low endotracheal tube positions.
Conclusion:
The predominance of upper lobe and, in particular, right upper lobe collapse observed in pediatric intensive care patients contrasts with the high incidence of lower lobe collapse in their adult counterparts. Multiple interrelated factors are likely to be contributory and include the following: a) anatomical and physiological differences between adults and children; b) the pathophysiology of childhood respiratory disease; c) more critical positioning of endotracheal tubes in younger patients and their movement with patient positioning.