Lung aeration changes after lung recruitment in children with acute lung injury: A feasibility study

Pediatric Pulmonology, 03/23/2012

Boriosi JP et al. – Lung recruitment results in improved lung aeration as detected by lung tomography. This is accompanied by improvements in oxygenation and ventilation. However, the clinical significance of these findings is uncertain. Transporting patients in early ALI to the CT–scanner seems safe and feasible.

Methods

  • To describe CT-scan lung aeration changes and gas exchange after lung recruitment in pediatric ALI and assess the safety of transporting patients in the acute phase of ALI to the CT-scanner.
  • The authors present a case series completed in a subset of six patients enrolled in previously published study of efficacy and safety of lung recruitment in pediatric patients with ALI. Intervention: RM using incremental positive end-expiratory pressure.

Results

  • There was a variable increase in aerated and poorly aerated lung after the RM ranging from 3% to 72%.
  • All patients had improvement in the ratio of partial pressure of arterial oxygen over fraction of inspired oxygen (PaO2/FiO2) after the RM.
  • There was a decrease in the partial pressure of arterial carbon dioxide (PaCO2) in four of six subjects after the RM.
  • One subject had transient hypercapnia (41% increase in PaCO2) during the RM and this correlated with the smallest increase (3%) in aerated and poorly aerated lung.
  • All patients tolerated the RM without hemodynamic compromise, barotrauma, hypoxemia, or dysrhythmias.

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