Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver
OBJECTIVE:Regional differences in lung volume have been described in adults with acute respiratory distress syndrome, but it remains unclear to what extent they occur in children. To quantify regional alveolar collapse that occurred during mechanical ventilation during a standardized suctioning mane...
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| Veröffentlicht in: | Critical care medicine 2007-08, Vol.35 (8), p.1972-1978 |
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| container_end_page | 1978 |
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| container_issue | 8 |
| container_start_page | 1972 |
| container_title | Critical care medicine |
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| creator | Wolf, Gerhard K Grychtol, Bartlomiej Frerichs, Inez van Genderingen, Huibert R Zurakowski, David Thompson, John E Arnold, John H |
| description | OBJECTIVE:Regional differences in lung volume have been described in adults with acute respiratory distress syndrome, but it remains unclear to what extent they occur in children. To quantify regional alveolar collapse that occurred during mechanical ventilation during a standardized suctioning maneuver, we evaluated regional and global relative impedance changes (relative ΔZ) in children with acute respiratory distress syndrome using electrical impedance tomography.
DESIGN:Prospective observational trial.
SETTING:A 30-bed pediatric intensive care unit.
PATIENTS:Six children with acute respiratory distress syndrome.
INTERVENTIONS:Standardized suctioning maneuver.
MEASUREMENTS AND MAIN RESULTS:By comparing layers from nondependent (layers 1 and 2) to dependent lung areas (layers 3 and 4), it was demonstrated that the middle layers (2 and 3) had the greatest ventilation-induced change in relative ΔZ; layer 4 showed the least ventilation-induced change in relative ΔZ. During suctioning, layers 1, 2, and 3 showed a negative change in relative ΔZ, whereas layer 4 showed no significant change in relative ΔZ. The derecruitment-induced change in relative ΔZ representing the lung-volume loss was −9.8 (−3.0 mL/kg) during the first suctioning maneuver, −16.1 (−5.4 mL/kg) during the second, and −21.7 (−7.4 mL/kg) during the third. The ventilation-induced change in relative ΔZ during mechanical ventilation remained unchanged after suctioning (mean change in relative ΔZ before vs. after suctioning, 40.1 ± 9.1 vs. 41.4 ± 10.8; p = .30). Dynamic compliance was 11.8 ± 6.1 mL·cm H2O before and 11.8 ± 6.9 mL·cm H2O after the suctioning sequence (p = .90).
CONCLUSIONS:Considerable regional heterogeneity was present during ventilation and a derecruitment maneuver. Significantly lower change in relative ΔZ in the most dependent lung regions suggests alveolar collapse during ventilation before suctioning. |
| doi_str_mv | 10.1097/01.CCM.0000275390.71601.83 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68166087</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>68166087</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4023-8d293c17409f68881b4949e0b835dcc8fe5101726383fd30c85f16a1c32fbc183</originalsourceid><addsrcrecordid>eNqNkFtvEzEQRi0EomnhLyALCd42nVnvxcsDUhVBqVRUqYJny_HOJgbvbupLo_x7DImUV_zii843Mz6MvUdYInTtNeBytfq-hLzKthYdLFts8qMUL9gCawEFlJ14yRYAHRSi6sQFuwzhFwBWdSteswtsa4mVxAV7eqSNnSftuEvThj_PLo3EzVZPGwrcTvloXe9p4nsbt1ybFIl7CjvrdZz9gfc2xHwPPBym3s853CdvcynNe_JkfLJxpCnyUU-Unsm_Ya8G7QK9Pe1X7OfXLz9W34r7h9u71c19YSooRSH7_AeDbQXd0EgpcV11VUewlqLujZED1QjYlo2QYugFGFkP2Gg0ohzWBqW4Yh-PdXd-fkoUohptMORcnmNOQTUSmwZkm8FPR9D4OQRPg9p5O2p_UAjqr3AFqLJwdRau_glXUuTwu1OXtB6pP0dPhjPw4QToYLQbvJ6MDWdOdkJg1WTu85Hbzy6SD79d2pNXW9Iubv9nkj94xZ3d</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>68166087</pqid></control><display><type>article</type><title>Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Wolf, Gerhard K ; Grychtol, Bartlomiej ; Frerichs, Inez ; van Genderingen, Huibert R ; Zurakowski, David ; Thompson, John E ; Arnold, John H</creator><creatorcontrib>Wolf, Gerhard K ; Grychtol, Bartlomiej ; Frerichs, Inez ; van Genderingen, Huibert R ; Zurakowski, David ; Thompson, John E ; Arnold, John H</creatorcontrib><description>OBJECTIVE:Regional differences in lung volume have been described in adults with acute respiratory distress syndrome, but it remains unclear to what extent they occur in children. To quantify regional alveolar collapse that occurred during mechanical ventilation during a standardized suctioning maneuver, we evaluated regional and global relative impedance changes (relative ΔZ) in children with acute respiratory distress syndrome using electrical impedance tomography.
DESIGN:Prospective observational trial.
SETTING:A 30-bed pediatric intensive care unit.
PATIENTS:Six children with acute respiratory distress syndrome.
INTERVENTIONS:Standardized suctioning maneuver.
MEASUREMENTS AND MAIN RESULTS:By comparing layers from nondependent (layers 1 and 2) to dependent lung areas (layers 3 and 4), it was demonstrated that the middle layers (2 and 3) had the greatest ventilation-induced change in relative ΔZ; layer 4 showed the least ventilation-induced change in relative ΔZ. During suctioning, layers 1, 2, and 3 showed a negative change in relative ΔZ, whereas layer 4 showed no significant change in relative ΔZ. The derecruitment-induced change in relative ΔZ representing the lung-volume loss was −9.8 (−3.0 mL/kg) during the first suctioning maneuver, −16.1 (−5.4 mL/kg) during the second, and −21.7 (−7.4 mL/kg) during the third. The ventilation-induced change in relative ΔZ during mechanical ventilation remained unchanged after suctioning (mean change in relative ΔZ before vs. after suctioning, 40.1 ± 9.1 vs. 41.4 ± 10.8; p = .30). Dynamic compliance was 11.8 ± 6.1 mL·cm H2O before and 11.8 ± 6.9 mL·cm H2O after the suctioning sequence (p = .90).
CONCLUSIONS:Considerable regional heterogeneity was present during ventilation and a derecruitment maneuver. Significantly lower change in relative ΔZ in the most dependent lung regions suggests alveolar collapse during ventilation before suctioning.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000275390.71601.83</identifier><identifier>PMID: 17581481</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Electric Impedance ; Emergency and intensive respiratory care ; Humans ; Injuries of the thorax. Foreign bodies. Diseases due to physical agents ; Intensive care medicine ; Lung Volume Measurements ; Medical sciences ; Monitoring, Physiologic - methods ; Positive-Pressure Respiration ; Prospective Studies ; Pulmonary Alveoli - physiopathology ; Respiratory Distress Syndrome, Adult - diagnosis ; Respiratory Distress Syndrome, Adult - therapy ; Suction ; Tomography - methods ; Traumas. Diseases due to physical agents</subject><ispartof>Critical care medicine, 2007-08, Vol.35 (8), p.1972-1978</ispartof><rights>2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4023-8d293c17409f68881b4949e0b835dcc8fe5101726383fd30c85f16a1c32fbc183</citedby><cites>FETCH-LOGICAL-c4023-8d293c17409f68881b4949e0b835dcc8fe5101726383fd30c85f16a1c32fbc183</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18933146$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17581481$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolf, Gerhard K</creatorcontrib><creatorcontrib>Grychtol, Bartlomiej</creatorcontrib><creatorcontrib>Frerichs, Inez</creatorcontrib><creatorcontrib>van Genderingen, Huibert R</creatorcontrib><creatorcontrib>Zurakowski, David</creatorcontrib><creatorcontrib>Thompson, John E</creatorcontrib><creatorcontrib>Arnold, John H</creatorcontrib><title>Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:Regional differences in lung volume have been described in adults with acute respiratory distress syndrome, but it remains unclear to what extent they occur in children. To quantify regional alveolar collapse that occurred during mechanical ventilation during a standardized suctioning maneuver, we evaluated regional and global relative impedance changes (relative ΔZ) in children with acute respiratory distress syndrome using electrical impedance tomography.
DESIGN:Prospective observational trial.
SETTING:A 30-bed pediatric intensive care unit.
PATIENTS:Six children with acute respiratory distress syndrome.
INTERVENTIONS:Standardized suctioning maneuver.
MEASUREMENTS AND MAIN RESULTS:By comparing layers from nondependent (layers 1 and 2) to dependent lung areas (layers 3 and 4), it was demonstrated that the middle layers (2 and 3) had the greatest ventilation-induced change in relative ΔZ; layer 4 showed the least ventilation-induced change in relative ΔZ. During suctioning, layers 1, 2, and 3 showed a negative change in relative ΔZ, whereas layer 4 showed no significant change in relative ΔZ. The derecruitment-induced change in relative ΔZ representing the lung-volume loss was −9.8 (−3.0 mL/kg) during the first suctioning maneuver, −16.1 (−5.4 mL/kg) during the second, and −21.7 (−7.4 mL/kg) during the third. The ventilation-induced change in relative ΔZ during mechanical ventilation remained unchanged after suctioning (mean change in relative ΔZ before vs. after suctioning, 40.1 ± 9.1 vs. 41.4 ± 10.8; p = .30). Dynamic compliance was 11.8 ± 6.1 mL·cm H2O before and 11.8 ± 6.9 mL·cm H2O after the suctioning sequence (p = .90).
CONCLUSIONS:Considerable regional heterogeneity was present during ventilation and a derecruitment maneuver. Significantly lower change in relative ΔZ in the most dependent lung regions suggests alveolar collapse during ventilation before suctioning.</description><subject>Adolescent</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Electric Impedance</subject><subject>Emergency and intensive respiratory care</subject><subject>Humans</subject><subject>Injuries of the thorax. Foreign bodies. Diseases due to physical agents</subject><subject>Intensive care medicine</subject><subject>Lung Volume Measurements</subject><subject>Medical sciences</subject><subject>Monitoring, Physiologic - methods</subject><subject>Positive-Pressure Respiration</subject><subject>Prospective Studies</subject><subject>Pulmonary Alveoli - physiopathology</subject><subject>Respiratory Distress Syndrome, Adult - diagnosis</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Suction</subject><subject>Tomography - methods</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkFtvEzEQRi0EomnhLyALCd42nVnvxcsDUhVBqVRUqYJny_HOJgbvbupLo_x7DImUV_zii843Mz6MvUdYInTtNeBytfq-hLzKthYdLFts8qMUL9gCawEFlJ14yRYAHRSi6sQFuwzhFwBWdSteswtsa4mVxAV7eqSNnSftuEvThj_PLo3EzVZPGwrcTvloXe9p4nsbt1ybFIl7CjvrdZz9gfc2xHwPPBym3s853CdvcynNe_JkfLJxpCnyUU-Unsm_Ya8G7QK9Pe1X7OfXLz9W34r7h9u71c19YSooRSH7_AeDbQXd0EgpcV11VUewlqLujZED1QjYlo2QYugFGFkP2Gg0ohzWBqW4Yh-PdXd-fkoUohptMORcnmNOQTUSmwZkm8FPR9D4OQRPg9p5O2p_UAjqr3AFqLJwdRau_glXUuTwu1OXtB6pP0dPhjPw4QToYLQbvJ6MDWdOdkJg1WTu85Hbzy6SD79d2pNXW9Iubv9nkj94xZ3d</recordid><startdate>200708</startdate><enddate>200708</enddate><creator>Wolf, Gerhard K</creator><creator>Grychtol, Bartlomiej</creator><creator>Frerichs, Inez</creator><creator>van Genderingen, Huibert R</creator><creator>Zurakowski, David</creator><creator>Thompson, John E</creator><creator>Arnold, John H</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200708</creationdate><title>Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver</title><author>Wolf, Gerhard K ; Grychtol, Bartlomiej ; Frerichs, Inez ; van Genderingen, Huibert R ; Zurakowski, David ; Thompson, John E ; Arnold, John H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4023-8d293c17409f68881b4949e0b835dcc8fe5101726383fd30c85f16a1c32fbc183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Electric Impedance</topic><topic>Emergency and intensive respiratory care</topic><topic>Humans</topic><topic>Injuries of the thorax. Foreign bodies. Diseases due to physical agents</topic><topic>Intensive care medicine</topic><topic>Lung Volume Measurements</topic><topic>Medical sciences</topic><topic>Monitoring, Physiologic - methods</topic><topic>Positive-Pressure Respiration</topic><topic>Prospective Studies</topic><topic>Pulmonary Alveoli - physiopathology</topic><topic>Respiratory Distress Syndrome, Adult - diagnosis</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Suction</topic><topic>Tomography - methods</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wolf, Gerhard K</creatorcontrib><creatorcontrib>Grychtol, Bartlomiej</creatorcontrib><creatorcontrib>Frerichs, Inez</creatorcontrib><creatorcontrib>van Genderingen, Huibert R</creatorcontrib><creatorcontrib>Zurakowski, David</creatorcontrib><creatorcontrib>Thompson, John E</creatorcontrib><creatorcontrib>Arnold, John H</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wolf, Gerhard K</au><au>Grychtol, Bartlomiej</au><au>Frerichs, Inez</au><au>van Genderingen, Huibert R</au><au>Zurakowski, David</au><au>Thompson, John E</au><au>Arnold, John H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2007-08</date><risdate>2007</risdate><volume>35</volume><issue>8</issue><spage>1972</spage><epage>1978</epage><pages>1972-1978</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:Regional differences in lung volume have been described in adults with acute respiratory distress syndrome, but it remains unclear to what extent they occur in children. To quantify regional alveolar collapse that occurred during mechanical ventilation during a standardized suctioning maneuver, we evaluated regional and global relative impedance changes (relative ΔZ) in children with acute respiratory distress syndrome using electrical impedance tomography.
DESIGN:Prospective observational trial.
SETTING:A 30-bed pediatric intensive care unit.
PATIENTS:Six children with acute respiratory distress syndrome.
INTERVENTIONS:Standardized suctioning maneuver.
MEASUREMENTS AND MAIN RESULTS:By comparing layers from nondependent (layers 1 and 2) to dependent lung areas (layers 3 and 4), it was demonstrated that the middle layers (2 and 3) had the greatest ventilation-induced change in relative ΔZ; layer 4 showed the least ventilation-induced change in relative ΔZ. During suctioning, layers 1, 2, and 3 showed a negative change in relative ΔZ, whereas layer 4 showed no significant change in relative ΔZ. The derecruitment-induced change in relative ΔZ representing the lung-volume loss was −9.8 (−3.0 mL/kg) during the first suctioning maneuver, −16.1 (−5.4 mL/kg) during the second, and −21.7 (−7.4 mL/kg) during the third. The ventilation-induced change in relative ΔZ during mechanical ventilation remained unchanged after suctioning (mean change in relative ΔZ before vs. after suctioning, 40.1 ± 9.1 vs. 41.4 ± 10.8; p = .30). Dynamic compliance was 11.8 ± 6.1 mL·cm H2O before and 11.8 ± 6.9 mL·cm H2O after the suctioning sequence (p = .90).
CONCLUSIONS:Considerable regional heterogeneity was present during ventilation and a derecruitment maneuver. Significantly lower change in relative ΔZ in the most dependent lung regions suggests alveolar collapse during ventilation before suctioning.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>17581481</pmid><doi>10.1097/01.CCM.0000275390.71601.83</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Child Child, Preschool Electric Impedance Emergency and intensive respiratory care Humans Injuries of the thorax. Foreign bodies. Diseases due to physical agents Intensive care medicine Lung Volume Measurements Medical sciences Monitoring, Physiologic - methods Positive-Pressure Respiration Prospective Studies Pulmonary Alveoli - physiopathology Respiratory Distress Syndrome, Adult - diagnosis Respiratory Distress Syndrome, Adult - therapy Suction Tomography - methods Traumas. Diseases due to physical agents |
| title | Regional lung volume changes in children with acute respiratory distress syndrome during a derecruitment maneuver |
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