Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children
American Journal of Pediatrics
Volume 4, Issue 2, June 2018, Pages: 41-45
Received: May 31, 2018;
Accepted: Jun. 21, 2018;
Published: Jul. 24, 2018
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Xie Youjun, Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Mo Wugui, Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Wei Yue, Department of Preventive Medicine, Guangxi Maternity and Child Health Hospital, Nanning, China
Wei Rong, Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Tang Yupeng, Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Fu Jun, Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Lu Gongzhi, Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO2) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH2O vs. (9.9±1.6) cmH2O, P<0.01]. Cdyn and oxygenation index (OI) in the two groups were improved, and the degree of improvement in the treatment group was significantly higher than that in the control group [Cdyn after the experiment at 2 h: (0.39±0.03) mL/(cmH2O.kg) vs (0.36±0.03) mL/(cmH2O.kg), P<0.05; 24h: (0.40±0.03) mL/(cmH2O.kg) vs (0.38±0.03) mL/(cmH2O.kg), P<0.05; 48 h: (0.43±0.02) mL/(cmH2O.kg) vs. (0.40±0.02) mL/(cmH2O.kg), P<0.01; OI after the experiment at 24 h: (20.07±2.12) cmH2O/mmHg vs (21.94±2.05) cmH2O/mmHg, P<0.05; 48 h: (17.51±1.64) cmH2O/mmHg vs (19.82±2.07) cmH2O/mmHg, P<0.01]. There were no significant differences in heart rate, mean arterial pressure, and cardiac index before and after the experiment (all P>0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, P<0.05; 48 h: (76.67±9.23) ng/L vs (90.10±9.42) ng/L, P<0.01]. The length of mechanical ventilation and hospital stay in the PICU was significantly shorter in the treatment than in the control group [length of mechanical ventilation: (6.62±1.26) days vs (8.06±1.44) days; hospital stay in the PICU: (8.12±1.31) days vs (9.53±1.42) days, all P<0.05). There was no barotrauma and no difference in mortality between the two groups (P>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.
Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children, American Journal of Pediatrics.
Vol. 4, No. 2,
2018, pp. 41-45.
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