Lung Volume Optimization Maneuver Responses in Pediatric High-Frequency Oscillatory Ventilation

• Published in: American journal of respiratory and critical care medicine Vol. 199; no. 8; pp. 1034 - 1036
• Main Authors: de Jager, Pauline, Burgerhof, Johannes G M, Koopman, Alette A, Markhorst, Dick G, Kneyber, Martin C J
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.04.2019
• Subjects: Abdomen; Arterial Pressure - physiology; Child, Preschool; High-Frequency Ventilation - methods; Humans; Infant; Lung - pathology; Lung - physiology; Lung Diseases - therapy; Pediatrics; Plethysmography - methods; Proxies; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - therapy; Respiratory therapy; Tidal Volume - physiology; Ventilators; Netherlands
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201809-1769LE

[...]it is unclear whether clinical proxies for lung volume (i.e., transcutaneous oxygen saturation as measured by pulse oximetry [SpO ], oxygenation index, PaO /FIO , or proximal pressure amplitude [APproximal]) predict the outcome of recruitment (3, 4). Here, we report the use of respiratory inductive plethysmography (RIP) to map the inflation limb of the pressure-volume loop during a staircase continuous distending pressure (CDP) recruitment in pediatric patients with acute respiratory distress syndrome. Briefly, we mapped the inflation limb by increasing the CDP 2 cm H2O every 3-5 minutes with ongoing oscillations while simultaneously observing the SpO (as a proxy for lung volume) and mean arterial blood pressure (mABP), identifying the onset of lung recruitment (i.e., increase in SpOp CDPrecruitment) until no further improvement in SpOj and/or decrease in mABP (CDPhyperinflation) was observed during two consecutive increments. [...]a blood pressure decrease might not be the best marker for lung overdistension during a recruitment, as we did not always observe a change in mABP, although this is clinically often assumed.