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Pulmonary function variation in ventilator dependent critically ill infants on peritoneal dialysis
T E Bunchman1, M K Meldrum, J E Meliones
1Division of Pediatric Nephrology, Mott Children's Hospital, University of Michigan Hospitals, Ann Arbor.
Insights
Peritoneal dialysis (PD) in infants with acute renal failure can impair lung function. Increased intraperitoneal pressure (IPP) during PD significantly reduces pulmonary compliance and increases airway resistance, affecting blood gases.
Area of Science:
- Pediatric Nephrology
- Pulmonary Medicine
- Critical Care
Background:
- Infants with acute renal failure often require ventilatory support and renal replacement therapy.
- Peritoneal dialysis (PD) is a common modality for acute renal failure in infants.
- The impact of PD on pulmonary function in this vulnerable population is not well understood.
Purpose of the Study:
- To evaluate the effects of peritoneal dialysis on pulmonary function in ventilator-dependent infants with acute renal failure.
- To identify the relationship between intraperitoneal pressure (IPP) during PD and pulmonary function parameters.
Main Methods:
- Pulmonary function tests (PFTs) were performed on four ventilator-dependent infants undergoing PD for acute renal failure.
- PFTs were conducted at various time points within the PD cycle.
- Intraperitoneal pressure (IPP) was measured during the mid-dwell phase.
- Arterial blood gases (ABGs) were analyzed to assess gas exchange.
Main Results:
- A significant negative correlation was observed between mid-dwell peak IPP and pulmonary compliance.
- Increased IPP was associated with a significant increase in airway resistance.
- These changes in pulmonary mechanics correlated with decreased PO2 and increased PCO2 on ABGs.
- IPP appears to be the primary factor influencing PFT changes.
Conclusions:
- Peritoneal dialysis, particularly the associated increase in intraperitoneal pressure, can adversely affect pulmonary function in ventilator-dependent infants with acute renal failure.
- Further investigation is warranted to explore other potential contributing factors such as pulmonary artery shunting and dialysate composition.
Abstract:
Four ventilator dependent infants on PD for acute renal failure underwent pulmonary function (PFT) evaluation at varying times in the PD cycle. Mid dwell peak intraperitoneal pressure (IPP) correlated with a significant decrease in pulmonary compliance and increase in air way resistance. This further correlated with a decrease in PO2 and an increase in PCO2 on arterial blood gas analysis. Etiology of the PFT changes appear to correlate most closely with IPP yet other factors including pulmonary artery shunting as well as hypercapnea secondary to a 4.25% dialysate are being evaluated as additional causative factors.