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Lung aeration changes after lung recruitment in children with acute lung injury: a feasibility study
Juan P Boriosi1, Ronald A Cohen, Evan Summers
1Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin 53792-4108, USA. jpboriosi@pediatrics.wisc.edu
Insights
Lung recruitment maneuvers (RM) improved lung aeration and oxygenation in pediatric acute lung injury (ALI) patients. Transporting these critically ill children to CT-scans for monitoring was safe and feasible.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Medical Imaging
Background:
- Adult studies demonstrate computed tomography (CT) assessed lung aeration changes during recruitment maneuvers (RM) in acute lung injury (ALI).
- Limited data exists on RM effects on lung aeration in ventilated pediatric ALI patients.
Purpose of the Study:
- To describe CT-assessed lung aeration and gas exchange changes post-RM in pediatric ALI.
- To evaluate the safety of transporting pediatric ALI patients to CT for assessment.
Main Methods:
- Case series of six pediatric ALI patients undergoing RM with incremental positive end-expiratory pressure.
- CT scans were used to assess lung aeration changes.
- Gas exchange parameters (PaO2/FiO2, PaCO2) were monitored.
Main Results:
- Variable increases in aerated lung post-RM (median 20%).
- All patients showed improved oxygenation (PaO2/FiO2, median 14%).
- Four patients had decreased PaCO2; one experienced transient hypercapnia. All tolerated RM without adverse events.
Conclusions:
- RM improves lung aeration and oxygenation in pediatric ALI, detectable by CT.
- Clinical significance of aeration changes requires further investigation.
- CT transport for ALI patients appears safe and feasible.
Rationale:
There are several adult studies using computed tomography (CT-scan) to examine lung aeration changes during or after a recruitment maneuver (RM) in ventilated patients with acute lung injury (ALI). However, there are no published data on the lung aeration changes during or after a RM in ventilated pediatric patients with ALI.
Objective:
To describe CT-scan lung aeration changes and gas exchange after lung recruitment in pediatric ALI and assess the safety of transporting patients in the acute phase of ALI to the CT-scanner.
Methods:
We present a case series completed in a subset of six patients enrolled in our previously published study of efficacy and safety of lung recruitment in pediatric patients with ALI.
Intervention:
RM using incremental positive end-expiratory pressure.
Results:
There was a variable increase in aerated and poorly aerated lung after the RM ranging from 3% to 72% (median 20%; interquartile range 6, 47; P = 0.03). All patients had improvement in the ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (PaO(2) /FiO(2)) after the RM (median 14%; interquartile range: 8, 72; P = 0.03). There was a decrease in the partial pressure of arterial carbon dioxide (PaCO(2)) in four of six subjects after the RM (median -5%; interquartile range: -9, 2; P = 0.5). One subject had transient hypercapnia (41% increase in PaCO(2)) during the RM and this correlated with the smallest increase (3%) in aerated and poorly aerated lung. All patients tolerated the RM without hemodynamic compromise, barotrauma, hypoxemia, or dysrhythmias.
Conclusions:
Lung recruitment results in improved lung aeration as detected by lung tomography. This is accompanied by improvements in oxygenation and ventilation. However, the clinical significance of these findings is uncertain. Transporting patients in early ALI to the CT-scanner seems safe and feasible.
