Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study

González-Pizarro, Patricio; García-Fernández, Javier; Canfrán, Susana; Gilsanz, F.

doi:10.4187/respcare.04250

Cited by 11 publications

(4 citation statements)

References 28 publications

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“…The occurrence of barotrauma, including pneumomediastinum and pneumothorax, has been reported with the intermittent increase in peak airway inspiratory pressures (10,27,28). In our study, there was no significant difference in the occurrence of pneumothorax between the two groups.…”

Section: Discussioncontrasting

confidence: 48%

“…However, lung recruitments using positive pressure have been shown to re-expand collapsed alveoli and improve RV function (23)(24)(25)(26). There is a theoretical risk of developing barotrauma leading to pneumomediastinum or pneumothorax during a recruitment; however this is likely less a risk in cardiac surgical patients with relatively healthy lungs (10,27,28).…”

Section: Introductionmentioning

confidence: 99%

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Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients

Devor¹,

Bassi²,

Kang³

et al. 2020

Southwest J Pulm Crit Care

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Background: Recruitment maneuvers are a dynamic process of transient increases in transpulmonary pressure intended to open unstable airless alveoli. Due to concerns regarding the hemodynamic consequences of recruitment maneuvers in children with heart disease, these maneuvers have not been widely utilized in this population. The objective of this study was to demonstrate the safety and efficacy of lung recruitment maneuvers in post-operative pediatric cardiac patients. We hypothesized that multiple recruitment maneuvers are physiologically beneficial and hemodynamically tolerated in children with congenital cardiac disease. Methods: Retrospective chart review was conducted of post-operative cardiac surgical subjects who received recruitment maneuvers, as well as a matched control group who did not, at a Cardiac ICU in a quaternary care free-standing children's hospital. Repetitive lung recruitment maneuvers using incremental positive end-expiratory pressure were performed. Hemodynamic and respiratory physiologic variables were recorded. Results: Sixty-one post-operative cardiac subjects had a total of 435 lung recruitment maneuvers. Assessment of hemodynamic tolerability demonstrated no change in MAP, HR, or CVP during or after the maneuvers. There was a 28% increase in dynamic compliance following recruitment maneuvers (p <0.01, 95% CI). Specific outcomes in the 59 matched control subjects demonstrated no significant difference in length of mechanical ventilation (p = 0.26), length of hospital stay (p = 0.28), mortality (p = 0.58) or difference in occurrence of pneumothorax (p = 0.26).

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients

Devor¹,

Bassi²,

Kang³

et al. 2020

Southwest J Pulm Crit Care

View full text Add to dashboard Cite

show abstract

“…Literature on the pathophysiology during pneumothorax is outrageously scarce compared with its high incidence [ 20 ]. An experimental study in rats showed that PIP is the only relevant factor that determines pneumothorax [ 21 ]. Briassoulis et al showed that mechanical ventilation produced air leakages, particularly when high peak airway pressures (barotrauma) or large tidal volumes (volutrauma) were delivered by the ventilator [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for air leakage during invasive mechanical ventilation in pediatric intensive care units

Yin

Yang

et al. 2022

Eur J Med Res

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Purpose This study aimed to investigate air leakage during invasive mechanical ventilation (IMV) in a pediatric intensive care unit (PICU) and explore potential risk factors. Methods We conducted a retrospective cohort study of children who underwent IMV in a single-center PICU in a tertiary referral hospital. Air leakage risk factors and factors associated with an improved outcome were assessed. Results A total of 548 children who underwent IMV were enrolled in this study. Air leakage occurred in 7.5% (41/548) of the cases in the PICU. Air leakage increased the duration of IMV and hospitalization time. Multivariate logistic regression analysis showed a higher risk of air leakage during IMV for PICU patients with acute respiratory dyspnea syndrome (ARDS) (OR = 4.38), a higher pediatric critical illness score (PCIS) (OR = 1.08), or a higher peak inspiratory pressure (PIP) (OR = 1.08), whereas the risk was lower for patients with central respiratory failure (OR = 0.14). The logistic model had excellent predictive power for air leakage, with an area under the curve of 0.883 and tenfold cross-validation. Patients aged between 1 and 6 years who were diagnosed with measles or pneumonia and had a low positive end-expiratory pressure (PEEP) or high PaO2/FiO2 ratio were associated with improved outcomes. Patients diagnosed with central respiratory failure or congenital heart diseases were associated with less desirable outcomes. Conclusions Patients with ARDS, a higher PCIS at admission or a higher PIP were at higher risk of air leakage.

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“…Evidence supports the safety of employing recruitment maneuvers in neonatal models [ 15 ]. LRMs have been found to have no deleterious effects on systemic hemodynamics (including arterial blood pressure, central venous pressure, and cardiac output), as well as on respiratory parameters (air trapping and pneumothorax) [ 16 , 17 ]. However, the impact of these maneuvers on cerebral perfusion in neonatal brain models remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Impact of Stepwise Recruitment Maneuvers on Cerebral Hemodynamics: Experimental Study in Neonatal Model

Berrocal

Bilotta

et al. 2023

JPM

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Background: Lung recruitment maneuvers (LRMs) have been demonstrated to be effective in avoiding atelectasis during general anesthesia in the pediatric population. Performing these maneuvers is safe at the systemic hemodynamic and respiratory levels. Aims: We aimed to evaluate the impact of a stepwise LRM and individualized positive end-expiratory pressure (PEEP) on cerebral hemodynamics in an experimental neonatal model. Methods: Eleven newborn pigs (less than 72 h old, 2.56 ± 0.18 kg in weight) were included in the study. The LRM was performed under pressure-controlled ventilation with a constant driving pressure (15 cmH2O) in a stepwise increasing PEEP model. The target peak inspiratory pressure (PIP) was 30 cmH2O and the PEEP was 15 cmH2O. The following hemodynamic variables were monitored using the PICCO® system: mean arterial pressure (MAP), central venous pressure (CVP), and cardiac output (CO). The cerebral hemodynamics variables monitored were intracranial pressure (ICP) (with an intraparenchymal Camino® catheter) and cerebral oxygen saturation (rSO2) (with the oximetry monitor INVOS 5100® system). The following respiratory parameters were monitored: oxygen saturation, fraction of inspired oxygen, partial pressure of oxygen, end-tidal carbon dioxide pressure, Pmean, PEEP, static compliance (Cstat), and dynamic compliance (Cdyn). Results: All LRMs were safely performed as scheduled without any interruptions. Systemic hemodynamic stability was maintained during the lung recruitment maneuver. No changes in ICP occurred. We observed an improvement in rSO2 after the maneuver (+5.8%). Conclusions: Stepwise LRMs are a safe tool to avoid atelectasis. We did not observe an impairment in cerebral hemodynamics but an improvement in cerebral oxygenation.

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Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study

Cited by 11 publications

References 28 publications

Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients

Safety and efficacy of lung recruitment maneuvers in pediatric post-operative cardiac patients

Risk factors for air leakage during invasive mechanical ventilation in pediatric intensive care units

Impact of Stepwise Recruitment Maneuvers on Cerebral Hemodynamics: Experimental Study in Neonatal Model

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