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Efficacy and safety of lung recruitment in pediatric patients with acute lung injury

Boriosi, Juan P. MD; Sapru, Anil MD; Hanson, James H. MD; Asselin, Jeanette MS, RT; Gildengorin, Ginny PhD; Newman, Vivienne MD, FCP (SA), FAAP; Sabato, Katie MS, RT; Flori, Heidi R. MD

Pediatric Critical Care Medicine: July 2011 - Volume 12 - Issue 4 - p 431-436
doi: 10.1097/PCC.0b013e3181fe329d
Feature Articles

Objective: To assess the safety and efficacy of a recruitment maneuver, the Open Lung Tool, in pediatric patients with acute lung injury and acute respiratory distress syndrome.

Design: Prospective cohort study using a repeated-measures design.

Setting: Pediatric intensive care unit at an urban tertiary children's hospital.

Patients: Twenty-one ventilated pediatric patients with acute lung injury.

Intervention: Recruitment maneuver using incremental positive end-expiratory pressure.

Measurements and Main Results: The ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (Pao2/Fio2 ratio) increased 53% immediately after the recruitment maneuver. The median Pao2/Fio2 ratio increased from 111 (interquartile range, 73–266) prerecruitment maneuver to 170 (interquartile range, 102–341) immediately postrecruitment maneuver (p < .01). Improvement in Pao2/Fio2 ratio persisted with an increase of 80% over the baseline at 4 hrs and 40% at 12 hrs after the recruitment maneuver. The median Pao2/Fio2 ratio was 200 (interquartile range, 116–257) 4 hrs postrecruitment maneuver (p < .05) and 156 (interquartile range, 127–236) 12 hrs postrecruitment maneuver (p < .01). Compared with prerecruitment maneuver, the partial pressure of arterial carbon dioxide (Paco2) was significantly decreased at 4 hrs postrecruitment maneuver but not immediately after the recruitment maneuver. The median Paco2 was 49 torr (interquartile range, 44–60) prerecruitment maneuver compared with 48 torr (interquartile range, 43–50) immediately postrecruitment maneuver (p = .69), 45 torr (interquartile range, 41–50) at 4 hrs postrecruitment maneuver (p < .01), and 43 torr (interquartile range, 38–51) at 12 hrs postrecruitment maneuver. Recruitment maneuvers were well tolerated except for significant increase in Paco2 in three patients. There were no serious adverse events related to the recruitment maneuver.

Conclusions: Using the modified open lung tool recruitment maneuver, pediatric patients with acute lung injury may safely achieve improved oxygenation and ventilation with these benefits potentially lasting up to 12 hrs postrecruitment maneuver.

From the Department of Pediatrics (JPB), University of Wisconsin, Madison, WI; the Department of Pediatrics (AS), University of California, San Francisco CA; Kaiser Permanente Group (JHH), Oakland, CA; Children's Hospital and Research Center Oakland (JA), Oakland, CA; Children's Hospital Oakland Research Institute (GG), Oakland, CA; and Pediatric Critical Care (VN), Respiratory Care (KS), and Pediatric Critical Care (HRF), Children's Hospital and Research Center Oakland, Oakland, CA.

Supported by an institutional departmental fund from the Charlotte Coleman Frey Foundation and Clinical Translational Science Institute/Clinical Research Center grant UL1RR024131-01.

The present work was performed at the Pediatric Critical Care Department, Children's Hospital and Research Center Oakland, Oakland, CA.

The authors have not disclosed any potential conflict of interest.

For information regarding this article, E-mail: jpboriosi@pediatrics.wisc.edu

©2011The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies