Fernanda Md Junqueira, Isabel S Ferraz, Fábio J Campos, Toshio Matsumoto, Marcelo B Brandão, Roberto Jn Nogueira, Tiago H de Souza
{"title":"增加 PEEP 对小儿 ARDS 的血液动力学、呼吸力学和氧合的影响。","authors":"Fernanda Md Junqueira, Isabel S Ferraz, Fábio J Campos, Toshio Matsumoto, Marcelo B Brandão, Roberto Jn Nogueira, Tiago H de Souza","doi":"10.4187/respcare.12005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS.</p><p><strong>Methods: </strong>Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H<sub>2</sub>O, and again to 5 cm H<sub>2</sub>O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected.</p><p><strong>Results: </strong>A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H<sub>2</sub>O was significantly lower than that observed at any other PEEP level (<i>P</i> = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H<sub>2</sub>O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H<sub>2</sub>O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H<sub>2</sub>O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H<sub>2</sub>O).</p><p><strong>Conclusions: </strong>Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"1409-1416"},"PeriodicalIF":2.4000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549636/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Impact of Increased PEEP on Hemodynamics, Respiratory Mechanics, and Oxygenation in Pediatric ARDS.\",\"authors\":\"Fernanda Md Junqueira, Isabel S Ferraz, Fábio J Campos, Toshio Matsumoto, Marcelo B Brandão, Roberto Jn Nogueira, Tiago H de Souza\",\"doi\":\"10.4187/respcare.12005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS.</p><p><strong>Methods: </strong>Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H<sub>2</sub>O, and again to 5 cm H<sub>2</sub>O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected.</p><p><strong>Results: </strong>A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H<sub>2</sub>O was significantly lower than that observed at any other PEEP level (<i>P</i> = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H<sub>2</sub>O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H<sub>2</sub>O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H<sub>2</sub>O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H<sub>2</sub>O).</p><p><strong>Conclusions: </strong>Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.</p>\",\"PeriodicalId\":21125,\"journal\":{\"name\":\"Respiratory care\",\"volume\":\" \",\"pages\":\"1409-1416\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549636/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Respiratory care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4187/respcare.12005\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4187/respcare.12005","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：PEEP 是儿科 ARDS 患儿的基础治疗方法。遗憾的是，其滴定通常仅通过评估血氧饱和度来进行，这可能导致 PEEP 水平设置不当，从而产生不良影响。本研究旨在评估增加 PEEP 对 ARDS 患儿血液动力学、呼吸系统力学和氧合的影响：方法：对接受机械通气并使用压力控制容量保证模式的儿童进行前瞻性评估。PEEP 依次变为 5、12、10、8 cm H2O，然后再次变为 5 cm H2O。在每个 PEEP 水平下 10 分钟后，收集血液动力学、通气和氧合变量：共纳入 31 名受试者，中位年龄和体重分别为 6 个月和 6.3 千克。儿童入住重症监护室的主要原因是急性病毒性支气管炎（45%）和社区获得性肺炎（32%）引起的呼吸衰竭。大多数受试者患有轻度或中度 ARDS（分别占 45% 和 42%），氧合指数中位数（四分位数间距）为 8.4（5.8-12.7）。增加 PEEP 后，血氧饱和度明显改善。然而，虽然血压没有明显变化，但 PEEP 为 12 cm H2O 时的中位心脏指数明显低于其他任何 PEEP 水平（P = .001）。当 PEEP 增加到 12 cm H2O 时，14 名参与者（45%）的心脏指数下降了 10%。此外，在 12 cm H2O PEEP 时，估计的氧气输送量也明显降低。最后，当 PEEP 增加时，呼吸系统顺应性明显降低。当 PEEP 为 12 cm H2O 时，静态顺应性的中位数比初始评估（PEEP 为 5 cm H2O）降低了 25%：结论：不适当的高 PEEP 水平虽然可以提高动脉血氧饱和度，但对于肺募集潜力较低的 ARDS 儿科受试者来说，可能会降低心输出量、供氧量和呼吸系统顺应性。
The Impact of Increased PEEP on Hemodynamics, Respiratory Mechanics, and Oxygenation in Pediatric ARDS.
Background: PEEP is a cornerstone treatment for children with pediatric ARDS. Unfortunately, its titration is often performed solely by evaluating oxygen saturation, which can lead to inadequate PEEP level settings and consequent adverse effects. This study aimed to assess the impact of increasing PEEP on hemodynamics, respiratory system mechanics, and oxygenation in children with ARDS.
Methods: Children receiving mechanical ventilation and on pressure-controlled volume-guaranteed mode were prospectively assessed for inclusion. PEEP was sequentially changed to 5, 12, 10, 8 cm H2O, and again to 5 cm H2O. After 10 min at each PEEP level, hemodynamic, ventilatory, and oxygenation variables were collected.
Results: A total of 31 subjects were included, with median age and weight of 6 months and 6.3 kg, respectively. The main reasons for pediatric ICU admission were respiratory failure caused by acute viral bronchiolitis (45%) and community-acquired pneumonia (32%). Most subjects had mild or moderate ARDS (45% and 42%, respectively), with a median (interquartile range) oxygenation index of 8.4 (5.8-12.7). Oxygen saturation improved significantly when PEEP was increased. However, although no significant changes in blood pressure were observed, the median cardiac index at PEEP of 12 cm H2O was significantly lower than that observed at any other PEEP level (P = .001). Fourteen participants (45%) experienced a reduction in cardiac index of > 10% when PEEP was increased to 12 cm H2O. Also, the estimated oxygen delivery was significantly lower, at 12 cm H2O PEEP. Finally, respiratory system compliance significantly reduced when PEEP was increased. At a PEEP of 12 cm H2O, static compliance had a median reduction of 25% in relation to the initial assessment (PEEP of 5 cm H2O).
Conclusions: Although it may improve arterial oxygen saturation, inappropriately high PEEP levels may reduce cardiac output, oxygen delivery, and respiratory system compliance in pediatric subjects with ARDS with low potential for lung recruitability.
期刊介绍：
RESPIRATORY CARE is the official monthly science journal of the American Association for Respiratory Care. It is indexed in PubMed and included in ISI''s Web of Science.
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