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Respiratory and hemodynamic effects of a stepwise lung recruitment maneuver in pediatric ARDS: a feasibility study

Pablo Cruces1, Alejandro Donoso, Jorge Valenzuela

  • 1Área de Cuidados Críticos, Hospital Padre Hurtado, Santiago, Chile; Department of Pediatrics, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.

Pediatric Pulmonology
|December 21, 2012
PubMed

Insights

Recruitment maneuvers (RMs) and decremental PEEP titration are safe and effective in improving lung function and oxygenation in pediatric acute respiratory distress syndrome (ARDS) patients. These procedures enhanced lung mechanics and gas exchange, with a high success rate and minimal adverse events.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Efficacy and safety of recruitment maneuvers (RMs) in pediatric acute respiratory distress syndrome (ARDS) are not well understood.
  • Assessed effects of sequential RMs and decremental positive end-expiratory pressure (PEEP) titration on gas exchange and lung mechanics in pediatric ARDS.

Purpose of the Study:

  • To evaluate the safety and efficacy of sequential lung recruitment maneuvers (RMs) combined with decremental PEEP titration in pediatric ARDS patients.
  • To assess the impact on gas exchange and lung mechanics, and identify potential detrimental effects.

Main Methods:

  • Enrolled pediatric patients (<15 years) with ARDS, hypoxemia, <72 hours of mechanical ventilation, and hemodynamic stability.
  • Performed stepwise RMs and decremental PEEP trials, monitoring for hypotension, oxygen desaturation, and airleaks.
  • Evaluated changes in lung compliance (Cdyn) and gas exchange (PaO2/FiO2) at 1, 12, and 24 hours post-maneuver.

Main Results:

  • Included 25 pediatric patients (median age 5 months). All 30 RMs were completed successfully with no airleaks and only mild, transient hypotension in four instances.
  • Significant improvements in lung compliance (Cdyn) and oxygenation (PaO2/FiO2) were observed post-RM (P < 0.01), with 90% showing >25% improvement.
  • While 36% required high-frequency oscillatory ventilation (HFOV) later due to gas exchange worsening, others sustained improved oxygenation; 28-day mortality was 16%.

Conclusions:

  • Sequential RMs and decremental PEEP titration are safe and well-tolerated in hemodynamically stable pediatric ARDS patients.
  • These maneuvers can effectively improve lung function and gas exchange in children with severe hypoxemia due to ARDS.
Abstract

Keywords:
acute respiratory distress syndromehemodynamichypoxemiapediatricsrecruitment

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