Postural lung recruitment assessed by lung ultrasound in mechanically ventilated children

Tusman, Gerardo; Acosta, Cecilia; Böhm, Stephan H.; Waldmann, Andreas D.; Ferrando, Carlos; Márquez, María Dolores Benítez; Suárez-Sipmann, Fernando

doi:10.1186/s13089-017-0073-0

Cited by 19 publications

(33 citation statements)

References 30 publications

(37 reference statements)

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“…Box-plot showing the aeration score after anesthesia induction (T1) and after 3 min of 10 cmH 2 O of PEEP in the control (C group) and postural recruitment maneuver (P-RM group) groups. Inter-group comparison, Student's t test: a C group vs P-RM group at T2, p < 0.0001. b P-RM group T1 vs T2, p < 0.0001 on the postural recruitment effect [9] and reinforce the feasibility and reproducibility of the P-RM in ventilated pediatric patients with healthy lungs in the clinical field. Four patients in the P-RM group presented residual atelectasis in the left lower para-diaphragmatic areas (Fig.…”

Section: Discussionsupporting

confidence: 57%

“…However, there are still concerns about the hemodynamic response and the mechanic stress and strain on the lung tissue caused by the maneuver in this population. In order to avoid these concerns, we have described a postural recruitment maneuver (P-RM), i.e., a ventilatory strategy aimed to obtain a lung recruitment effect by changes in body position under constant driving pressure at a moderate level of PEEP [9].…”

Section: Introductionmentioning

confidence: 99%

“…The P-RM is based on the known gravitational effect on P L . Two principles explain its rationale [9]: one postulates that dorsal atelectasis can be recruited by placing this lung area in the uppermost position, which increases the local P L . The other principle follows the Laplace's Law, which indicates that, once recruited; a ventral lung area will maintain patency when enough PEEP is applied.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of postural lung recruitment maneuver in children: a randomized, controlled study

et al. 2020

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Background: Pulmonary atelectasis in anesthetized children is easily reverted by lung recruitment maneuvers. However, the high airways pressure reached during the maneuver could negatively affect hemodynamics. The aim of this study is to assess the effect and feasibility of a postural lung recruitment maneuver (P-RM); i.e., a new maneuver that opens up the atelectatic lung areas based on changing the child's body position under constant ventilation with moderated driving pressure (12 cmH 2 O) and of positive end-expiratory pressure (PEEP, 10 cmH 2 O). Forty ASA I-II children, aged 6 months to 7 years, subjected to general anesthesia were studied. Patients were ventilated with volume control mode using standard settings with 5 cmH 2 O of PEEP. They were randomized into two groups: (1) control group (C group, n = 20)-ventilation was turned to pressure control ventilation using a fixed driving pressure of 12 cmH 2 O. PEEP was increased from 5 to 10 cmH 2 O during 3 min maintaining the supine position. (2) P-RM group (n = 20)-patients received the same increase in driving pressure and PEEP, but they were placed, respectively, in the left lateral position, in the right lateral position (90 s each), and back again into the supine position after 3 min. Then, ventilation returned to baseline settings in volume control mode. Lung ultrasound-derived aeration score and respiratory compliance were assessed before (T1) and after (T2) 10 cmH 2 O of PEEP was applied. Results: At baseline ventilation (T1), both groups showed similar aeration score (P-RM group 9.9 ± 1.9 vs C group 10.4 ± 1.9; p = 0.463) and respiratory compliance (P-RM group 15 ± 6 vs C group 14 ± 6 mL/cmH 2 O; p = 0.517). At T2, the aeration score decreased in the P-RM group (1.5 ± 1.6 vs 9.9 ± 2.1; p < 0.001), but remained without changes in the C group (9.9 ± 2.1; p = 0.221). Compliance was higher in the P-RM group (18 ± 6 mL/cmH 2 O) when compared with the C group (14 ± 5 mL/cmH 2 O; p = 0.001). Conclusion: Lung aeration and compliance improved only in the group in which a posture change strategy was applied.

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Section: Discussionsupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Feasibility of postural lung recruitment maneuver in children: a randomized, controlled study

et al. 2020

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“…Although many studies and opinion articles focus on assessment of lung aeration using transthoracic lung US in scenarios other than ARDS, such as anesthesia, hemodialysis, pneumonia, postextubation distress, and cardiogenic pulmonary edema, evidence for using lung US in ARDS is limited to date, and extrapolation of data should be cautious, given the unique characteristics of the lungs in ARDS.…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Bello

Blanco

2018

J of Ultrasound Medicine

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Acute respiratory distress syndrome (ARDS) constitutes a high burden for intensive care units. Although several methods are proposed to monitor aeration in ARDS, availability, costs, simplicity, and hazards (eg, ionizing radiation) limit the use of many of them at patients' bedsides. Given the widespread use of lung ultrasonography (US) in intensive care units, research is growing regarding its use to monitor aeration in patients with ARDS. We reviewed the actual role of lung US in ARDS and its potential impact in practice. Lung US can be readily used for assessing aeration, although, as a main limitation, a normal lung cannot be distinguished from hyperinflation. Additionally, an improvement in aeration by lung US does not always correlate with an increase in oxygenation. Lung US can be considered the main imaging method for monitoring aeration in ARDS, but in view of its limitations, it should not be used in isolation. Further studies are needed to validate lung US in large ARDS populations.

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“…Mechanical ventilation promotes alveolar derecruitment, atelectasis and increases physiological intrapulmonary shunt (1,2). This can lead to impaired oxygen exchange.…”

Section: Introductionmentioning

confidence: 99%

Slow PEEP Titration During General Anesthesia with Muscle Paralysis Improves Lung Function Without Compromising Hemodynamic Stability in Preschool Children: A Randomized Control Clinical Trial

et al. 2019

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Background: Mechanical ventilation impairs oxygenation and increases intrapulmonary shunt. Positive end-expiratory pressure (PEEP) slows derecruitment, improves lung function but can compromise hemodynamics. Objectives: To asses slow PEEP titration effect on intrapulmonary shunt, oxygenation and hemodynamics in preschool children on mechanical ventilation under general anesthesia. Methods: This was a single tertiary care center an open-label, randomized parallel group controlled clinical trial. Study included 70 children, 3-7 years, ASA I and II, under general anesthesia for non-cardiothoracic surgery. Children were randomly allocated either to receive PEEP titration 5-11 cmH2O 20 minutes before the end of anesthesia (intervention group) or to be ventilated until the end of anesthesia with constant positive end-expiratory pressure of 3 cmH2O (control group). Main outcome measures were changes in oxygenation index (PaO2/FiO2) and alveolar-arterial gradient (P(A-a)O2) between and within groups and changes in systolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) in interventional group during PEEP trial. Results: Seventy children were recruited and analyzed. P(A-a)O2 and PaO2/FiO2 improved in interventional group comparing to control as consequence of PEEP titration (∆PaO2/FiO2-30.3 vs. 0.52; P < 0.001; ∆P(A-a)O2 6.7 vs.-1.0; P < 0.001) and within interventional group before and after PEEP titration (PaO2/FiO2 522.0 vs. 552.3; P < 0.01; P(A-a)O2 20.1 vs. 13.3; P < 0.001). Hypotension and bradycardia were not documented. Conclusions: Slow PEEP titration up to 11 cmH2O improves oxygenation, reduces intrapulmonary shunt without causing hemodynamic instability in preschool children during general anesthesia.

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Postural lung recruitment assessed by lung ultrasound in mechanically ventilated children

Cited by 19 publications

References 30 publications

Feasibility of postural lung recruitment maneuver in children: a randomized, controlled study

Feasibility of postural lung recruitment maneuver in children: a randomized, controlled study

Lung Ultrasonography for Assessing Lung Aeration in Acute Respiratory Distress Syndrome: A Narrative Review

Slow PEEP Titration During General Anesthesia with Muscle Paralysis Improves Lung Function Without Compromising Hemodynamic Stability in Preschool Children: A Randomized Control Clinical Trial

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