Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cruces, Pablo; González‐Dambrauskas, Sebastián; Quilodran, Julio; Valenzuela, Jorge; Martínez, Javier; Rivero, Natalia; Arias, Pablo; Díaz, Franco

doi:10.1186/s12890-017-0475-6

Cited by 25 publications

(27 citation statements)

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“…They observed reopening of the collapsed lung with addition of 5 cmH 2 O of PEEP for 5 min [ 14 ]. Kadini et al, in a small study of 8 anesthetized children (range between 2.5 and 6.5 years old), described that 5 cmH 2 O resulted in a significant increase of VT; thus, C RS improved [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is little evidence to guide MV during general anesthesia in children [ 18 , 22 , 23 ]. MV parameters are primarily dependent on anesthesiologist preferences and on the characteristics of anesthesia machines [ 24 ]. Facing this scenario, many scientific societies have pointed as priority areas of research to the pathophysiology, respiratory mechanics and practice of MV in children for improving outcomes and reducing secondary long-term lung injury [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Positive end-expiratory pressure improves elastic working pressure in anesthetized children

et al. 2018

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BackgroundPositive end-expiratory pressure (PEEP) has been demonstrated to decrease ventilator-induced lung injury in patients under mechanical ventilation (MV) for acute respiratory failure. Recently, some studies have proposed some beneficial effects of PEEP in ventilated patients without lung injury. The influence of PEEP on respiratory mechanics in children is not well known. Our aim was to determine the effects on respiratory mechanics of setting PEEP at 5 cmH2O in anesthetized healthy children.MethodsPatients younger than 15 years old without history of lung injury scheduled for elective surgery gave informed consent and were enrolled in the study. After usual care for general anesthesia, patients were placed on volume controlled MV. Two sets of respiratory mechanics studies were performed using inspiratory and expiratory breath hold, with PEEP 0 and 5 cmH2O. The maximum inspiratory and expiratory flow (QI and QE) as well as peak inspiratory pressure (PIP), plateau pressure (PPL) and total PEEP (tPEEP) were measured. Respiratory system compliance (CRS), inspiratory and expiratory resistances (RawI and RawE) and time constants (KTI and KTE) were calculated. Data were expressed as median and interquartile range (IQR). Wilcoxon sign test and Spearman’s analysis were used. Significance was set at P < 0.05.ResultsWe included 30 patients, median age 39 (15–61.3) months old, 60% male. When PEEP increased, PIP increased from 12 (11,14) to 15.5 (14,18), and CRS increased from 0.9 (0.9,1.2) to 1.2 (0.9,1.4) mL·kg− 1·cmH2O− 1; additionally, when PEEP increased, driving pressure decreased from 6.8 (5.9,8.1) to 5.8 (4.7,7.1) cmH2O, and QE decreased from 13.8 (11.8,18.7) to 11.7 (9.1,13.5) L·min− 1 (all P < 0.01). There were no significant changes in resistance and QI.ConclusionsAnalysis of respiratory mechanics in anesthetized healthy children shows that PEEP at 5 cmH2O places the respiratory system in a better position in the P/V curve. A better understanding of lung mechanics may lead to changes in the traditional ventilatory approach, limiting injury associated with MV.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0611-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Positive end-expiratory pressure improves elastic working pressure in anesthetized children

et al. 2018

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“…A recent study conducted on infants < 12 months of age affected by bronchiolitis and on MV confirmed that the elastic component is the strongest constituent of working pressure, thus describing bronchiolitis as a restrictive disease, beside the obstructive pattern. 17 These findings are of particular relevance, since they influence the ventilation parameters during MV of infected infants.…”

Section: Invasive Respiratory Supportmentioning

confidence: 95%

Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

Bresesti

Lista

2020

Am J Perinatol

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Acute respiratory infections are very common medical emergency in early infancy, often requiring hospitalization. The most frequent respiratory infection at this stage of life is bronchiolitis, with a benign course in the majority of cases. However, especially during neonatal period, infants are at higher risk for developing complications, and ventilatory support of various degrees is needed. The two most widespread methods to provide noninvasive respiratory support are heated humidified high-flow nasal cannula and nasal continuous positive airway pressure. They are both used in neonatal intensive care unit to treat respiratory distress syndrome of the premature infants, and the main concept of recruiting and distending alveoli is valid also for respiratory failure occurring during bronchiolitis. However, there is still ongoing debate about the superiority of one method, and their real efficacy still need to be confirmed. Once respiratory failure does not respond to noninvasive ventilation, more intensive care must be provided in the form of conventional mechanical ventilation or high-frequency ventilation. There is currently no evidence of the optimal ventilation strategy to use, and a deeper comprehension of the pulmonary mechanics during bronchiolitis would be desirable to tailor ventilation according to the degree of severity. Further research is then urgently needed to better clarify these aspects. Key Points

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Section: Introductionmentioning

confidence: 99%

“…14 15 All this implies a functional impairment of bronchioles, which may cause excessive work of breathing, hypoxia and hypercapnia, sometimes requiring invasive mechanical ventilation (IMV). 16 In 12 infants with viral bronchiolitis requiring intubation, Dargaville et al 14 observed an impaired functional activity of endogenous surfactant, which resolved after clinical healing of the disease. Subsequent studies reported alterations in both surfactant proteins and pulmonary surface tension, using the 'pulsating bubble surfactometer' method or the 'click test' in tracheal aspirates obtained from children with bronchiolitis.…”

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Efficacy and safety of exogenous surfactant therapy in patients under 12 months of age invasively ventilated for severe bronchiolitis (SURFABRON): protocol for a multicentre, randomised, double-blind, controlled, non-profit trial

et al. 2020

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IntroductionSome evidence indicates that exogenous surfactant therapy may be effective in infants with acute viral bronchiolitis, even though more confirmatory data are needed. To date, no large multicentre trials have evaluated the effectiveness and safety of exogenous surfactant in severe cases of bronchiolitis requiring invasive mechanical ventilation (IMV).Methods and analysisThis is a multicentre randomised, placebo-controlled, double-blind study, performed in 19 Italian paediatric intensive care units (PICUs). Eligible participants are infants under the age of 12 months hospitalised in a PICU, suffering from severe acute hypoxaemic bronchiolitis, requiring IMV. We adopted a more restrictive definition of bronchiolitis, including only infants below 12 months of age, to maintain the population as much homogeneous as possible. The primary outcome is to evaluate whether exogenous surfactant therapy (Curosurf, Chiesi Pharmaceuticals, Italy) is effective compared with placebo (air) in reducing the duration of IMV in the first 14 days of hospitalisation, in infants suffering from acute hypoxaemic viral bronchiolitis. Secondary outcomes are duration of non-invasive mechanical ventilation in the post-extubation phase, number of cases requiring new intubation after previous extubation within 14 days from randomisation, PICU and hospital length of stay (LOS), duration of oxygen dependency, effects on oxygenation and ventilatory parameters during invasive mechanical respiratory support, need for repeating treatment within 24 hours of first treatment, use of other interventions (eg, high-frequency oscillatory ventilation, nitric oxide, extracorporeal membrane oxygenation), mortality within the first 14 days of PICU stay and before hospital discharge, side effects and serious adverse events.Ethics and disseminationThe trial design and protocol have received approval by the Italian National Agency for Drugs (AIFA) and by the Regional Ethical Committee of Verona University Hospital (1494CESC). Findings will be disseminated through publication in peer-reviewed journals, conference/meeting presentations and media.Trial registration numberClinicaltrials.gov, issue date 22 May 2019. NCT03959384.

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Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation

Cited by 25 publications

References 26 publications

Positive end-expiratory pressure improves elastic working pressure in anesthetized children

Positive end-expiratory pressure improves elastic working pressure in anesthetized children

Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

Efficacy and safety of exogenous surfactant therapy in patients under 12 months of age invasively ventilated for severe bronchiolitis (SURFABRON): protocol for a multicentre, randomised, double-blind, controlled, non-profit trial

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