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Equilibration Time Required for Respiratory System Compliance and Oxygenation Response Following Changes in Positive End-Expiratory Pressure in Mechanically Ventilated Children

Smallwood, Craig D., BS, RRT1,2,3; Walsh, Brian K., PhD, RRT-NPS1,2; Arnold, John H., MD1,2; Gouldstone, Andrew, PhD3,4

doi: 10.1097/CCM.0000000000003001
Online Clinical Investigations

Objectives: Increases in positive end-expiratory pressure are implemented to improve oxygenation through the recruitment and stabilization of collapsed alveoli. However, the time it takes for a positive end-expiratory pressure change to have maximum effect upon oxygenation and pulmonary compliance has not been adequately described in children. Therefore, we sought to quantify the time required for oxygenation and pulmonary system compliance changes in children requiring mechanical ventilation.

Design: Retrospective analysis of continuous data.

Settings: Multidisciplinary ICU of a pediatric university hospital.

Patients: Mechanically ventilated pediatric subjects.

Interventions: A case was eligible for analysis if during a 90-minute window following an increase in positive end-expiratory pressure, no other changes to the ventilator were made, ventilator and physiologic data were continuously available and a positive oxygenation response was observed. Time to 90% (T90) of the maximum change in oxygenation and compliance was computed. Differences between oxygenation and compliance T90 were compared using a paired t test. The effect of severity of illness (by oxygen saturation index) upon oxygenation and compliance was analyzed.

Measurements and Main Results: A total of 200 subjects were enrolled and 1,150 positive end-expiratory pressure change cases were analyzed. Of these, 54 subjects with 171 positive end-expiratory pressure change case were included in the analysis (67% were responders).

Changes in dynamic compliance (T90 = 38 min) preceded changes in oxygenation (T90 = 71 min; p < 0.001). Oxygenation response differed depending on severity of illness quantified by oxygen saturation index; lung dysfunction was associated with a longer response time (p = 0.001).

Conclusions: T90 requires 38 and 71 minutes for dynamic pulmonary compliance and oxygenation, respectively; the latter was directly observed to be dependent upon severity of illness. To our knowledge, this is the first report of oxygenation and compliance equilibration data following positive end-expiratory pressure increases in pediatric mechanically ventilated subjects.

1Division of Critical Care Medicine, Department of Anesthesia, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA.

2Harvard Medical School, Boston, MA.

3Department of Bioengineering, Northeastern University, Boston, MA.

4Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA.

This work was performed at Boston Children’s Hospital.

Dr. Smallwood received funding from the American Association of Respiratory Care ($500 honorarium for lecture) and the Respiratory Care Society of Washington ($800 for two lectures at state scientific meeting). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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