Optimal Positive End-Expiratory Pressure Therapy in Infants and Children with Acute Respiratory Failure1

Mk, White; Sa, Galli; Rl, Chatburn; Jl, Blumer

doi:10.1203/00006450-198808000-00016

Cited by 28 publications

(9 citation statements)

References 26 publications

(49 reference statements)

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“… 16 Additionally, both the cardiac index and pulmonary compliance were well maintained at 12 cm H 2 O PEEP in infants and children with acute respiratory failure. 17 Although the degree of blood pressure reduction with 10 cm H 2 O PEEP in the supine position was not considered clinically relevant in our study, it should be kept in mind that it does not imply that a high PEEP is safe in patients with complex congenital heart defects. An additional limitation of the present study was that ultrasound measurements are a user-dependent technology.…”

Section: Discussionmentioning

confidence: 74%

Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

Kim

Choi

Lee³

et al. 2016

Medicine

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Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery.In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured.All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment.The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.

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Section: Discussionmentioning

confidence: 74%

Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

Kim

Choi

Lee³

et al. 2016

Medicine

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“…Measurement of Rrs is highly dependent on lung volume [12,18]. It is therefore important to monitor all clinical variables that are dependent on lung volume in RDS: improved arterial Pa,O 2 and a/A ratio may reflect to some degree increased functional residual capacity (FRC) [19,20]. In spontaneously breathing infants there is still tonic activity of the diaphragm and intercostal muscles at the end of an expiration.…”

Section: Discussionmentioning

confidence: 99%

Effect of fluticasone propionate and salmeterol on <I>Pseudomonas aeruginosa</I> infection of the respiratory mucosa <I>in vitro</I>

Dowling¹,

Johnson²,

Cole³

et al. 1999

European Respiratory Journal

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Paralysis of ventilated newborn babies does not influence resistance of the total respiratory system. R. Burger, S. Fanconi, B. Simma. #ERS Journals Ltd 1999. ABSTRACT: Paralysis with pancuronium bromide is used in newborn infants to facilitate ventilatory support during respiratory failure. Changes in lung mechanics have been attributed to paralysis. The aim of this study was to examine whether or not paralysis per se has an influence on the passive respiratory mechanics, resistance (Rrs) and compliance (Crs) of the respiratory system in newborn infants.In 30 infants with acute respiratory failure, Rrs was measured during paralysis with pancuronium bromide and after stopping pancuronium bromide (group A). Rrs was also measured in an additional 10 ventilated infants in a reversed fashion (group B): Rrs was measured first in nonparalysed infants and then they were paralysed, mainly for diagnostic procedures, and the Rrs measurement repeated. As Rrs is highly dependent on lung volume, several parameters, that depend directly on lung volume were recorded: inspiratory oxygen fraction (FI,O 2 ), arterial oxygen tension/alveolar oxygen tension (a/A) ratio and volume above functional residual capacity (FRC).In group A, the Rrs was not different during (0.2360.09 cmH 2 O . s . mL -1 ) and after (0.2370.07 cmH 2 O . s . mL -1 ) paralysis. Also, in group B, Rrs did not change (0.207 0.046 versus 0.2210.046 cm . s . mL -1 without versus with pancuronium bromide). FI,O 2 , a/A ratio and volume above FRC remained constant during paralysis.These data demonstrate that paralysis does not influence the resistance of the total respiratory system in ventilated term and preterm infants when measured at comparable lung volumes.

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“…Measurement of R rs is highly dependent on lung volume [12, 18]. It is therefore important to monitor all clinical variables that are dependent on lung volume in RDS: improved arterial P a,O 2 and a/A ratio may reflect to some degree increased functional residual capacity (FRC) [19, 20]. In spontaneously breathing infants there is still tonic activity of the diaphragm and intercostal muscles at the end of an expiration.…”

Section: Discussionmentioning

confidence: 99%

Paralysis of ventilated newborn babies does not influence resistance of the total respiratory system

1999

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A. Krakowiak, B. Szulc, P. Go Â rski Allergy to laboratory animals in children of parents occupationally exposed to mice, rats and hamsters. A. Krakowiak, B. Szulc, P. Go Ârski. #ERS Journals Ltd 1999. ABSTRACT: Sensitization to laboratory animals (LA) has a high prevalence among laboratory workers. It is unknown whether transportation of LA allergens can be a risk factor for sensitization of subjects outside the laboratory environment. The aim of the study was to investigate the prevalence of sensitization to LA among children whose parents were and were not occupationally exposed to LA.The first group consisted of 50 children (age 12.3 4.3 yrs) whose parents were occupationally exposed to mice, rats and hamsters. The second group consisted of 40 children (age (mean SD) 10.8 3.0 yrs) whose parents were not occupationally exposed to LA. Children having LA at home were eliminated from the study. All children responded to a questionnaire, underwent spirometry and were also tested with skin prick tests with the use of common allergens and prick tests with hair extracts from mouse, hamster and rat. Total immunoglobulin (Ig)E levels and the presence of specific IgE against LA were also estimated.Children of parents occupationally exposed to LA presented significantly more positive skin prick tests against allergens from the hair of laboratory animals compared to children of nonexposed parents. Five children from the first group were also found to have specific IgE against LA, with three of these five children complaining of rhinitis and cough while visiting their parents' workplace.It is concluded that the observed increased sensitization to laboratory animals among children of occupationally exposed parents could be the result of poor hygienic conditions at their parents' workplace. Hence, parents' job seems to be an additional risk factor of sensitization and should be taken into consideration when recording an allergic history.

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Optimal Positive End-Expiratory Pressure Therapy in Infants and Children with Acute Respiratory Failure1

Cited by 28 publications

References 26 publications

Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

Effect of fluticasone propionate and salmeterol on <I>Pseudomonas aeruginosa</I> infection of the respiratory mucosa <I>in vitro</I>

Paralysis of ventilated newborn babies does not influence resistance of the total respiratory system

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