Objective To assess the safety and efficacy of a recruitment maneuver, the Open Lung Tool, in pediatric patients with acute lung injury and acute respiratory distress syndrome. Design Prospective cohort study using a repeated-measures design. Setting Pediatric intensive care unit at an urban tertiary children's hospital. Patients Twenty-one ventilated pediatric patients with acute lung injury. Intervention Recruitment maneuver using incremental positive end-expiratory pressure. Measurements and Main Results The ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (PaO2/FIO2 ratio) increased 53% immediately after the recruitment maneuver. The median PaO2/FIO2 ratio increased from 111 (interquartile range, 73–266) prerecruitment maneuver to 170 (interquartile range, 102–341) immediately postrecruitment maneuver (p < .01). Improvement in PaO2/FIO2 ratio persisted with an increase of 80% over the baseline at 4 hrs and 40% at 12 hrs after the recruitment maneuver. The median PaO2/FIO2 ratio was 200 (interquartile range, 116–257) 4 hrs postrecruitment maneuver (p < .05) and 156 (interquartile range, 127–236) 12 hrs postrecruitment maneuver (p < .01). Compared with prerecruitment maneuver, the partial pressure of arterial carbon dioxide (PaCO2) was significantly decreased at 4 hrs postrecruitment maneuver but not immediately after the recruitment maneuver. The median PaCO2 was 49 torr (interquartile range, 44–60) prerecruitment maneuver compared with 48 torr (interquartile range, 43–50) immediately postrecruitment maneuver (p = .69), 45 torr (interquartile range, 41–50) at 4 hrs postrecruitment maneuver (p < .01), and 43 torr (interquartile range, 38–51) at 12 hrs postrecruitment maneuver. Recruitment maneuvers were well tolerated except for significant increase in PaCO2 in three patients. There were no serious adverse events related to the recruitment maneuver. Conclusions Using the modified open lung tool recruitment maneuver, pediatric patients with acute lung injury may safely achieve improved oxygenation and ventilation with these benefits potentially lasting up to 12 hrs postrecruitment maneuver.

BACKGROUND: Bronchodilator treatment for asthma can be provided with various aerosolgenerating devices and methods. There have been no randomized trials of a breath-actuated nebulizer versus continuous 1-hour nebulization and/or small-volume constant-output nebulizer in pediatric asthma patients. METHODS: We conducted a randomized study of one-time albuterol treatment with the AeroEclipse breath-actuated nebulizer versus standard therapy (single treatment via small-volume nebulizer or 1-hour of continuous nebulized albuterol) in pediatric asthma patients in the emergency department. Eligible patients were those admitted to the emergency department, 0 months to 18 years of age, who presented with asthma or wheezing. We assessed all the patients with our clinical asthma scoring system and peak-flow measurement if possible. We stratified the patients by clinical asthma score and weight, and then randomized them to receive their initial albuterol treatment in the emergency department via either AeroEclipse or standard therapy. We recorded time in the emergency department, change in clinical asthma score, need for additional bronchodilator treatments, need for admission, patient response, ability to actuate the AeroEclipse, and adverse effects. RESULTS: We enrolled 149 patients between October 14, 2004 and November 11, 2005, and we randomized 84 patients to AeroEclipse and 65 to standard therapy. The cohort's average age was 5.5 years. There were no significant differences in demographics. The initial mean clinical asthma scores were 5.1 ؎ 2.4 in the AeroEclipse group, and 5.1 ؎ 2.1 in the standard-therapy group. Time in the emergency department was not different (AeroEclipse 102 min, standard therapy 125 min, P ‫؍‬ .10), but the AeroEclipse group had a significantly greater improvement in clinical asthma score (1.9 ؎ 1.2 vs 1.2 ؎ 1.4, P ‫؍‬ .001) and respiratory rate (P ‫؍‬ .002), and significantly lower admission rate (38% vs 57%, P ‫؍‬ .03). There was no difference in adverse effects. CONCLUSIONS: Although AeroEclipse did not reduce the time in the ED, it significantly improved clinical asthma score, decreased admissions, and decreased respiratory rate.

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