ASSOBRAFIR Ciência
https://assobrafirciencia.org/article/doi/10.47066/2177-9333.AC.2020.0042
ASSOBRAFIR Ciência
Original Research

Titration of positive end-expiratory pressure with electrical impedance tomography in pediatrics

Elaine Campos de Carvalho, Lorena Carla Mendes de Azevedo, Mary Lucy Ferraz Maia Fiuza de Mello, Emmerson Carlos Franco de Farias, Susan Carolina Diniz de Sales, Maria de Nazaré Gomes Mesquita, Guilherme Euzébio Lemes, Letícia de Barros Rocha, Larissa Salgado de Oliveira Rocha, Paulo Eduardo Santos Avila, Rodrigo Santiago Barbosa Rocha

Downloads: 1
Views: 125

Abstract

Background: Electrical impedance tomography (EIT) is widely used in the practice of patients with respiratory distress syndrome (ARDS), but little is known about the determination of adequate positive end-expiratory pressure (PEEP) in the pediatric intensive care unit. Aim: Evaluating the effects of titration of PEEP with EIT after alveolar recruitment in children with ARDS on ventilatory variables and blood gas analysis. Methods: This is a longitudinal analytical study carried out in the pediatric intensive care unit. The study included 5 patients diagnosed with ARDS, aged between 6 and 11 years and had an indication for alveolar recruitment maneuver (RM). The EIT belt was posicionated around the sternum and the ventilatory variables were collected (compliance, regional ventilation, driving pressure, alveolar overdistension, alveolar collapse and PEEP titration) and blood gas analysis. The RM was performed in steps, then PEEP titration was performed with the help of the EIT. Results: There was a significant improvement in the ventilatory variables and blood gas analysis of the participants after PEEP titration. The parameters that most changed the pre- and posttitration values were pulmonary compliance (p<0.05), alveolar overdistension (p<0.05), partial pressure of carbon dioxide (p<0.01), blood pressure of oxygen and arterial oxygen saturation (p<0.05). Conclusion: Titration of PEEP with the aid of EIT is safety, improving ventilation and basic acid balance in children with ARDS.

Keywords

Positive-Pressure Respiration; Ventilator-Induced Lung Injury; Respiratory Distress Syndrome

Referências

1. García-Laorden MI, Lorente JA, Flores C, Slutsky AS, Villar J. Biomarkers for the acute respiratory distress syndrome: how to make the diagnosis more precise. Ann Transl Med. 2017;5(14):283. http://dx.doi.org/10.21037/atm.2017.06.49. PMid:28828358.

2. Yehya N, Thomas NJ. Disassociating lung mechanics and oxygenation in pediatric acute respiratory distress syndrome. Crit Care Med. 2017;45(7):1232-9. http://dx.doi. org/10.1097/CCM.0000000000002406. PMid:28350644.

3. Aleksandrovich US, Pechueva OA, Pshenisnov KV. Alveolar recruitment maneuvers oxygenation effects in newborns with infant respiratory distress syndrome. Anesteziol Reanimatol. 2013;(1):21-5. PMid:23808248.

4. Chung FT, Lee CS, Lin SM, Kuo CH, Wang TY, Fang YF, et al. Alveolar recruitment maneuver attenuates extravascular lung water in acute respiratory distress syndrome. Medicine. 2017;96(30):e7627. http://dx.doi.org/10.1097/ MD.0000000000007627. PMid:28746224.

5. Ball L, Vercesi V, Costantino F, Chandrapatham K, Pelosi P. Lung imaging: how to get better look inside the lung. Ann Transl Med. 2017;5(14):294. http://dx.doi.org/10.21037/ atm.2017.07.20. PMid:28828369.

6. Boriosi JP, Sapru A, Hanson JH, Asselin J, Gildengorin G, Newman V, et al. Efficacy and safety of lung recruitment in pediatric patients with acute lung injury. Pediatr Crit Care Med. 2011;12(4):431-6. http://dx.doi.org/10.1097/ PCC.0b013e3181fe329d. PMid:21057351.

7. Duff JP, Rosychuk RJ, Joffe AR. The safety and efficacy of sustained inflations as a lung recruitment maneuver in pediatric intensive care unit patients. Intensive Care Med. 2007;33(10):1778-86. http://dx.doi.org/10.1007/s00134-007- 0764-2. PMid:17607560.

8. Frerichs I, Becher T, Weiler N. Electrical impedance tomography imaging of the cardiopulmonary system. Curr Opin Crit Care. 2014;20(3):323-32. http://dx.doi.org/10.1097/ MCC.0000000000000088. PMid:24739268.

9. Ngo C, Dippel F, Tenbrock K, Leonhardt S, Lehmann S. Flow-volume loops measured with electrical impedance tomography in pediatric patients with asthma. Pediatr Pulmonol. 2018;53(5):636-44. http://dx.doi.org/10.1002/ ppul.23962. PMid:29405616.

10. Durlak W, Kwinta P. Role of electrical impedance tomography in clinical practice in pediatric respiratory medicine. ISRN Pediatr. 2013;2013:529038. http://dx.doi. org/10.1155/2013/529038. PMid:24455294.

11. Mazzoni MB, Perri A, Plebani AM, Ferrari S, Amelio G, Rocchi A, et al. Electrical impedance tomography in children with community acquired pneumonia: preliminary data. Respir Med. 2017;130:9-12. http://dx.doi.org/10.1016/j. rmed.2017.07.001. PMid:29206639.

12. Aoyama H, Pettenuzzo T, Aoyama K, Pinto R, Englesakis M, Fan E. Association of driving pressure with mortality among ventilated patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med. 2018;46(2):300-6. http://dx.doi.org/10.1097/ CCM.0000000000002838. PMid:29135500.

13. Hess DR. Recruitment maneuvers and PEEP titration. Respir Care. 2015;60(11):1688-704. http://dx.doi.org/10.4187/ respcare.04409. PMid:26493593.

14. Dmytrowich J, Holt T, Schmid K, Hansen G. Mechanical ventilation guided by electrical impedance tomography in pediatric acute respiratory distress syndrome. J Clin Monit Comput. 2018;32(3):503-7. http://dx.doi.org/10.1007/ s10877-017-0048-5. PMid:28730574.

15. Sahetya SK, Goligher EC, Brower RG. Fifty years of research in ARDS. Setting positive end-expiratory pressure in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195(11):1429-38. http://dx.doi.org/10.1164/ rccm.201610-2035CI. PMid:28146639.

16. Wong JJ, Jit M, Sultana R, Mok YH, Yeo JG, Koh JWJC, et al. Mortality in pediatric acute respiratory distress syndrome: a systematic review and meta-analysis. J Intensive Care Med. 2019;34(7):563-71. http://dx.doi. org/10.1177/0885066617705109. PMid:28460591.

17. Plunkett A, Tong J. Sepsis in children. BMJ. 2015;350:h3017. http://dx.doi.org/10.1136/bmj.h3017. PMid:26060188.

18. Amorim EF, Guimaraes VA, Carmona F, Carlotti AP, Manso PH, Ferreira CA, et al. Alveolar recruitment manoeuvre is safe in children prone to pulmonary hypertensive crises following open heart surgery: a pilot study. Interact Cardiovasc Thorac Surg. 2014;18(5):602-6. http://dx.doi.org/10.1093/icvts/ ivt484. PMid:24480822.

19. Lista G, Castoldi F, Cavigioli F, Bianchi S, Fontana P. Alveolar recruitment in the delivery room. J Matern Fetal Neonatal Med. 2012;25(Suppl 1):39-40. http://dx.doi.org/10.3109/14 767058.2012.663164. PMid:22313342.

20. Pesenti A, Musch G, Lichtenstein D, Mojoli F, Amato MBP, Cinnella G,  et  al. Imaging in acute respiratory distress syndrome. Intensive Care Med. 2016;42(5):686-98. http:// dx.doi.org/10.1007/s00134-016-4328-1. PMid:27033882.


Submetido em:
30/07/2021

Aceito em:
21/12/2021

61e98ad0a953956b90717bf3 assobrafir Articles
Links & Downloads

ASSOBRAFIR Ciência

Share this page
Page Sections