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Published on: August 9, 2024
Pulmonary Functions in Children Ventilated for Acute Hypoxemic Respiratory Failure
Stanzen Chakdour1, Pankaj C Vaidya1, Suresh Kumar Angurana1
1Department of Pediatrics, Advanced Pediatrics Centre (APC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Insights
Children mechanically ventilated for acute hypoxemic respiratory failure often have subclinical pulmonary function abnormalities that improve over time. These lung function deficits did not limit physical activity in this study.
Area of Science:
- Pediatric critical care medicine
- Pulmonary medicine
- Respiratory physiology
Background:
- Mechanical ventilation is a critical intervention for acute hypoxemic respiratory failure in children.
- Long-term pulmonary sequelae following mechanical ventilation in pediatric populations require further investigation.
Purpose of the Study:
- To evaluate the pulmonary function outcomes in children who underwent mechanical ventilation for acute hypoxemic respiratory failure.
- To assess the persistence and progression of respiratory abnormalities post-mechanical ventilation.
Main Methods:
- A longitudinal study was conducted with children aged 5-12 years who were mechanically ventilated for acute hypoxemic respiratory failure.
- Pulmonary function was assessed through spirometry, 6-minute walk test, and chest radiography at 3 and 9-12 months post-PICU discharge.
- Clinical data, including ventilation parameters and oxygenation indices, were recorded at baseline.
Main Results:
- While most children showed normal physical activity and chest examinations at follow-up, significant spirometry abnormalities (82.7%) were observed at 3 months, improving to 18.5% at 9-12 months.
- A majority of the initial spirometry abnormalities were restrictive in nature.
- No correlation was found between pulmonary function and initial lung injury scores or ventilation parameters.
Conclusions:
- Children recovering from mechanical ventilation for acute hypoxemic respiratory failure may have persistent, albeit subclinical, pulmonary function deficits.
- These pulmonary function abnormalities tend to improve over time and do not typically limit physical activity.
- Further research with larger cohorts and updated pediatric acute respiratory distress syndrome criteria is recommended.
Objective:
To assess pulmonary functions of children who received mechanical ventilation for acute hypoxemic respiratory failure.
Design:
Longitudinal study.
Setting:
PICU and Pediatric Pulmonology Clinic of a tertiary care teaching hospital in North India.
Patients:
All children, 5-12 years old, ventilated for acute hypoxemic respiratory failure in PICU from July 2012 to June 2013 and survived.
Interventions:
The baseline admission variables recorded were as follows: age, sex, duration of illness, primary diagnosis at admission, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices, and duration of PICU stay. The children were followed up twice, at 3 and 9-12 months, after discharge from PICU and evaluated for any residual respiratory symptoms and signs, pulse oximetry, chest radiograph, 6-minute walk test, peak expiratory flow rate, and spirometry. Age, sex, duration of illness, primary diagnosis, Pediatric Risk of Mortality III score, lung injury score, mechanical ventilation parameters, oxygenation indices (PaO2/FIO2 ratio and oxygenation index), and duration of PICU stay were recorded from patient records.
Measurements And Main Results:
Twenty-nine children (25 boys and four girls; mean [SD] age, 8.4 [2.4] yr) were followed up at 3.5 (± 1.2) and 10.6 (± 2.7) months after discharge from PICU. Recurrent respiratory symptoms were noted in 37.9% patients (11/29) during first and in none during second follow-up. None had limitation of physical activity or need of supplemental oxygen. Chest examination was normal in all, except one during first follow-up, but 13.8% (4/29) had abnormal chest radiograph during first follow-up. Nearly all children could perform 6-minute walk test although mean distance walked increased significantly from first (352 ± 66.7 m) to second follow-up (401 ± 60.7 m; p = 0.002). Abnormal spirometry was seen in 82.7% (24/29) versus 18.5% (5/27) children during first and second follow-up visits, respectively (p = 0.0001). Most cases had restrictive abnormality (58.6% vs 11.1%; p = 0.002) during first and second follow-up, respectively. There was no correlation between pulmonary functions and lung injury scores, oxygenation indices (PaO2/FIO2 ratio and oxygenation index), and mechanical ventilation parameters.
Conclusions:
Significant number of children ventilated for acute hypoxemic respiratory failure had subclinical pulmonary function abnormality, without limiting physical activity, which improved over time. Further research on this topic with a larger sample size and patient categorization according to recent pediatric acute respiratory distress syndrome definition is needed.
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