Impact of optimal respiratory system dynamic compliance strategy for titrating positive end-expiratory pressure on the prognosis of acute respiratory distress syndrome in infants
10.3760/cma.j.issn.2095-428X.2015.06.012
- VernacularTitle:最佳呼吸系统动态顺应性设定呼气末正压对急性呼吸窘迫综合征婴幼儿预后的影响
- Author:
Youjun XIE
;
Wugui MO
;
Yue WEI
;
Rong WEI
;
Yupeng TANG
;
Jun FU
;
Gongzhi LU
- Publication Type:Journal Article
- Keywords:
Infant;
Positive end-expiratory pressure;
Respiratory system dynamic compliance;
Acute respiratory distress syndrome
- From:
Chinese Journal of Applied Clinical Pediatrics
2015;30(6):445-448
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the impact of optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP)on the prognosis of acute respiratory distress syndrome (ARDS) in infants.Methods A total of 30 patients with ARDS admitted in Pediatric Intensive Care Unit (PICU) of Guangxi Maternity and Child Health Hospital were divided into 2 groups randomly (n =15).PEEP was set in the control group according to PEEP/FiO2 in American ARDS collaboration while optimal Cdyn was for the treatment group.Pressure control ventilation(PCV) mode and small tidal volume(7 mL/kg)strategy were taken.Respiratory mechanics,hemodynamics and inflammatory cytokines were monitored in each group before and after experiment.The time of assisted ventilation,and the hospital stay in PICU and 28-day mortality were compared.Results (1) There was no significant differences in gender,age and severity of disease between the 2 groups (all P ＞ 0.05).(2) 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].(3) Cdyn and oxygenation index(OI) in 2 groups were all improved,and the degree of improvement in the treatment group was significantly better than that of 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; 24 h:(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/(cmH2 O · kg),P ＜ 0.01 ; OI after the experiment at 24 h:(20.07 ± 2.12) cmH2O/mmHg vs (21.94 ± 2.05),P ＜0.05 ; 48 h:(17.51 ± 1.64) cmH2O/mmHgvs (19.82 ± 2.07) cmH2O/mmHg,P ＜ 0.01] ; There were no significant differences in heart rate(HR),mean aerial pressure(MAP),cardiac index (CI) before and after the experiment (all P ＞ 0.05).(4) Interleukin-6 (IL-6) in two groups all decreased gradually,and the decrease in treatment group was more obvious than that of control group 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.(5) The lengths of assisted ventilation and the hospital stay in PICU of the treatment group were significantly less than that of the control group [length of assisted ventilation:(6.62 ± 1.26) d vs (8.06-± 1.44) d ; the hospital stay in PICU:(8.12 ± 1.31) d vs (9.53 ±1.42) d,all P ＜0.05].There had no barotrauma and the mortality was not distinct between the two groups(P ＞ 0.05).Conclusions Optimal Cdyn method for titrating PEEP improves respiratory mechanics of ARDS obviously,shortens the time of assisted ventilation,and has no serious adverse effect on hemodynamics.
