Cardiopulmonary parameters during high PEEP in children

Area of Science:

• Pediatric critical care medicine
• Respiratory physiology
• Mechanical ventilation

Background:

• Limited data exists on high positive end-expiratory pressure (PEEP) effects in pediatric patients.
• Cardiopulmonary parameters like cardiac index (CI), pulmonary venous admixture (Qsp/Qt), and arterial mixed venous oxygen content difference (avDO2) are not well-documented with high PEEP in this population.

Purpose of the Study:

• To evaluate the effects of high PEEP (≥15 cm H2O) on cardiopulmonary variables in infants and children.
• To assess the incidence of pulmonary barotrauma during mechanical ventilation with high PEEP in pediatric patients.

Main Methods:

• Retrospective analysis of 14 infants and children treated with high PEEP.
• Pulmonary artery catheters were used in 8 patients to obtain cardiopulmonary data.
• Pulmonary barotrauma data were collected from all 14 patients.

Main Results:

• At highest PEEP levels, mean CI was 3.6 L/min/M², avDO2 was 4.45 ml/dl, and Qsp/Qt was 16.7%.
• One patient experienced significant cardiac depression, which resolved upon PEEP reduction.
• Pulmonary barotrauma, including pneumothorax in 6 patients, was a frequent complication, though no deaths occurred.

Conclusions:

• High PEEP (≥15 cm H2O) can effectively decrease Qsp/Qt towards normal in pediatric patients.
• Cardiac index and avDO2 can typically be maintained within acceptable ranges.
• Close monitoring for pulmonary barotrauma is crucial when using high PEEP in infants and children.