Related Experiment Video
Updated: Nov 21, 2025
Ex Vivo Porcine Experimental Model for Studying and Teaching Lung Mechanics
Published on: April 19, 2024
ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
Marcela Salvador Galassi1, Rodrigo Genaro Arduini1, Orlei Ribeiro de Araújo1
1Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Insights
Alveolar recruitment maneuvers (ARMs) are feasible in children with cancer and ARDS, but offer only temporary oxygenation improvements. These procedures can lead to significant hemodynamic instability, despite being possible in patients with low platelet counts.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Oncology
- Respiratory Physiology
Background:
- Acute respiratory distress syndrome (ARDS) presents a significant challenge in pediatric cancer patients.
- Alveolar recruitment maneuvers (ARMs) are a potential intervention to improve oxygenation and survival in ARDS.
Purpose of the Study:
- To evaluate the feasibility and impact of ARMs in critically ill children with cancer and ARDS.
- To assess the safety and efficacy of ARMs in this vulnerable patient population.
Main Methods:
- Retrospective analysis of 31 ARMs in 12 pediatric cancer patients with ARDS.
- Application of high positive end-expiratory pressure (25-40 cmH2O) with a specific delta pressure (15 cmH2O) for 60 seconds.
- Assessment of blood gases, ventilation parameters, vital signs, hemoglobin, and barotrauma signs pre- and post-maneuvers.
Main Results:
- ARMs were feasible in patients with thrombocytopenia, with no radiological signs of barotrauma observed.
- Significant transient improvements in oxygenation (PaO2/FiO2 ratio) were noted post-ARMs.
- Two patients experienced significant hemodynamic compromise (MAP decrease >20%), requiring increased vasoactive support.
Conclusions:
- ARMs can be performed in pediatric cancer patients with ARDS, even with thrombocytopenia.
- While ARMs provide temporary oxygenation benefits, they are associated with significant risks of hemodynamic instability.
- The transient nature of oxygenation improvement and potential for instability warrant careful consideration of ARMs in this population.
Objective:
Acute respiratory distress syndrome (ARDS) can be a devastating condition in children with cancer and alveolar recruitment maneuvers (ARMs) can theoretically improve oxygenation and survival. The study aimed to assess the feasibility of ARMs in critically ill children with cancer and ARDS.
Methods:
We retrospectively analyzed 31 maneuvers in a series of 12 patients (median age of 8.9 years) with solid tumors (n=4), lymphomas (n=2), acute lymphoblastic leukemia (n=2), and acute myeloid leukemia (n=4). Patients received positive end-expiratory pressure from 25 up to 40 cmH20, with a delta pressure of 15 cmH2O for 60 seconds. We assessed blood gases pre- and post-maneuvers, as well as ventilation parameters, vital signs, hemoglobin, clinical signs of pulmonary bleeding, and radiological signs of barotrauma. Pre- and post-values were compared by the Wilcoxon test.
Results:
Median platelet count was 53,200/mm3. Post-maneuvers, mean arterial pressure decreased more than 20% in two patients, and four needed an increase in vasoactive drugs. Hemoglobin levels remained stable 24 hours after ARMs, and signs of pneumothorax, pneumomediastinum, or subcutaneous emphysema were absent. Fraction of inspired oxygen decreased significantly after ARMs (FiO2; p=0.003). Oxygen partial pressure (PaO2)/FiO2 ratio increased significantly (p=0.0002), and the oxygenation index was reduced (p=0.01), but all these improvements were transient. Recruited patients' 28-day mortality was 58%.
Conclusions:
ARMs, although feasible in the context of thrombocytopenia, lead only to transient improvements, and can cause significant hemodynamic instability.
More Related Videos
06:22Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
09:36Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:30Acute Respiratory Failure-III
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:23Acute Respiratory Failure-IV
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...