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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)

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Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver

Gerhard K Wolf1, Bartlomiej Grychtol, Inez Frerichs

  • 1Division of Critical Care Medicine, Department of Anesthesia, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. gerhard.wolf@childrens.harvard.edu

Critical Care Medicine
|June 22, 2007
PubMed

Insights

Children with acute respiratory distress syndrome (ARDS) experience significant lung collapse during mechanical ventilation, especially in dependent regions. Electrical impedance tomography (EIT) can quantify this lung volume loss during suctioning maneuvers.

Area of Science:

  • Pediatric critical care medicine
  • Respiratory physiology
  • Medical imaging techniques

Background:

  • Regional differences in lung volume are known in adult ARDS.
  • Limited data exists on regional lung changes in pediatric ARDS.
  • Mechanical ventilation and suctioning can impact lung volume.

Purpose of the Study:

  • To quantify regional alveolar collapse during mechanical ventilation in children with ARDS.
  • To assess lung volume changes during a standardized suctioning maneuver using EIT.
  • To investigate regional impedance changes in pediatric ARDS patients.

Main Methods:

  • Prospective observational trial in a pediatric intensive care unit.
  • Six children with acute respiratory distress syndrome were included.
  • Electrical impedance tomography (EIT) was used to measure relative impedance changes (relative DeltaZ).
  • A standardized suctioning maneuver was performed.

Main Results:

  • Significant regional heterogeneity in lung ventilation was observed.
  • Dependent lung regions (layer 4) showed the least ventilation-induced change in relative DeltaZ.
  • Suctioning caused negative changes in relative DeltaZ in nondependent and middle lung regions, indicating lung-volume loss.
  • Lung-volume loss increased with repeated suctioning maneuvers.
  • Mechanical ventilation's effect on relative DeltaZ and dynamic compliance remained unchanged after suctioning.

Conclusions:

  • Considerable regional heterogeneity in lung volume occurs in pediatric ARDS during ventilation and suctioning.
  • Alveolar collapse in dependent lung regions is suggested by reduced impedance changes.
  • EIT is a valuable tool for monitoring regional lung changes in pediatric ARDS.
Abstract

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