Impact of optimal respiratory system dynamic compliance strategy for titrating positive end- expiratory pressure on the prognosis of acute respiratory distress syndrome in infants

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 0.05). (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). 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. Key words: Infant; Positive end-expiratory pressure; Respiratory system dynamic compliance; Acute respi-ratory distress syndrome