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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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Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical

Cinara Andreolio1, Jefferson P Piva1, Francisco Bruno1

  • 1Pediatric Intensive Care Unit, Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil; UFRGS University, Rio Grande Do Sul, Brazil.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|February 19, 2021
PubMed

Insights

Infants with acute viral bronchiolitis (AVB) on mechanical ventilation (MV) show high airway resistance but these measures do not predict outcomes. Monitoring respiratory mechanics may guide MV strategy in AVB patients.

Area of Science:

  • Pediatric Intensive Care
  • Respiratory Physiology
  • Critical Care Medicine

Background:

  • Acute viral bronchiolitis (AVB) is a common pediatric lower airway disease.
  • AVB increases airway resistance and reduces pulmonary compliance in infants.
  • Understanding respiratory mechanics in AVB is crucial for optimizing mechanical ventilation (MV).

Purpose of the Study:

  • To assess respiratory mechanics in infants with AVB requiring MV.
  • To determine if respiratory mechanics predict outcomes in these infants.
  • To evaluate the relationship between respiratory parameters and MV support.

Main Methods:

  • Prospective observational study in two PICUs (Feb 2016 - Mar 2017).
  • Included infants (1 month-1 year) with AVB requiring MV >48 hours.
  • Measured auto-PEEP, dynamic compliance (Cdyn), static compliance (Cstat), expiratory resistance (ExRes), and inspiratory resistance (InRes) on days 2 and 3 of MV.

Main Results:

  • 64 infants evaluated; high InRes and ExRes (median 142 & 158 cmH2O/L/s) observed.
  • Decreased Cdyn and Cstat (0.46 & 0.81 mL/kg/cmH2O) were noted.
  • No respiratory mechanics variable predicted mortality, MV duration, or PICU length of stay.

Conclusions:

  • Infants with AVB on MV exhibit significantly elevated airway resistance.
  • These high resistance values may necessitate aggressive ventilatory settings like high PIP.
  • Monitoring respiratory mechanics can inform MV strategies for AVB patients.
Abstract

Keywords:
Airway resistanceLung complianceMechanical ventilationPediatricsViral bronchiolitis

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