Abstract
Background In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. However, no major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity).MethodsThe end-expiratory lung volume was measured using a simplified closed circuit helium dilution method. During an inspiratory and expiratory pause, the airway and esophageal pressure were measured. Transpulmonary pressure was computed as the difference between airway and esophageal pressure.ResultsTen intubated sedated paralyzed healthy children and ten children with ARDS underwent a PEEP trial (4 and 12 cmH2O) with a tidal volume of 8, 10 and 12 ml/kgIBW. The two groups were comparable for age and BMI (2.5 [1.0–5.5] vs 3.0 [1.7–7.2] years and 15.1 ± 2.4 vs 15.3 ± 3.0 kg/m2). The functional residual capacity in ARDS patients was significantly lower as compared to the control group (10.4 [9.1–14.3] vs 16.6 [11.7–24.6] ml/kg, p = 0.04). The ARDS patients had a significantly lower respiratory system and lung compliance as compared to control subjects (9.9 ± 5.0 vs 17.8 ± 6.5, 9.3 ± 4.9 vs 16.9 ± 4.1 at 4 cmH2O of PEEP and 11.7 ± 5.8 vs 23.7 ± 6.8, 10.0 ± 4.9 vs 23.4 ± 7.5 at 12 cmH2O of PEEP). The compliance of the chest wall was similar in both groups (76.7 ± 30.2 vs 94.4 ± 76.4 and 92.6 ± 65.3 vs 90.0 ± 61.7 at 4 and 12 cmH2O of PEEP). The lung stress and strain were significantly higher in ARDS patients as compared to control subjects and were poorly related to airway pressure and tidal volume normalized for body weight.ConclusionsAirway pressures and tidal volume normalized to body weight are poor surrogates for lung stress and strain in mild pediatric ARDS.Trial registration: Clinialtrials.gov NCT02036801. Registered 13 January 2014Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0113-0) contains supplementary material, which is available to authorized users.
Highlights
In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects
Contrary to adult acute respiratory distress syndrome (ARDS) patients, in which several randomized clinical studies have shown that the application of a lung protective ventilation ameliorated the final outcome [9, 10], in children with ARDS only few clinical studies have suggested a benefit of this strategy [11,12,13]
No major studies in children with ARDS have investigated the role of different levels of positive end-expiratory pressure (PEEP) and tidal volume on the partitioned respiratory mechanic, stress and strain [19, 20]
Summary
In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. No major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity). No major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (i.e., the transpulmonary pressure at end inspiration) and strain (the change in volume to the functional residual capacity) [19, 20]. The aim of this study was to evaluate in children with ARDS how the respiratory mechanics and stress/strain are affected compared with normal subjects
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