Lung Ventilation In Children Research Articles

Management of protective lung ventilation in children with a critical course of acute respiratory distress syndrome caused by SARS-CoV-2 coronavirus infection

the pandemic of coronavirus disease COVID-19 has created a serious threat to the public health system worldwide. With the beginning of the pandemic, it became clear that children infected by SARS-CoV-2, for unknown reasons, have a milder course compared to adults. In some cases, children are asymptomatic carriers of the infection. In light of today's scientific discoveries, contrary to initial reports, recent studies have shown that children are just as likely to contract the virus as adults, while vague symptoms and a milder course more often characterize the disease itself. However, it is worth noting that the true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated since children are not tested for COVID-19 without obvious clinical symptoms. This fact has been confirmed by multiple blood tests indicating high titers of IgG to SARS-CoV-2. Compared to adults, the typical clinical manifestations of COVID-19 in children are fever, runny nose, cough, and general weakness. The laboratory test results indicate a normal level of leukocytes, lymphopenia, and an increased level of aspartate aminotransferase, alanine aminotransferase, D-dimer, and MB creatine kinase. Currently, there is no sufficient evidence that the etiotropic therapy is 100% successful. Yet a course of action such as respiratory system protection, control of fluids and electrolyte homeostasis, anti-cytokine therapy, preventative measures for thrombosis, and treatment for bacterial superinfection proved to be efficient at preventing the development of possible complications caused by SARS-CoV-2. Therefore, it is important to collect and accumulate new experiences\cases of respiratory system protection management of an acute respiratory syndrome with a critical course of acute respiratory distress syndrome caused by COVID-19 and implement practical treatment plans for healthcare facilities. The results were analyzed using clinical epidemiology methods. Children were admitted to the intensive care unit on an average of 6,6±0,62 days of illness and were more associated with systemic disorders and water-electrolyte imbalance, which required prosthetic respiratory function, correction of hemodynamics and water-electrolyte disorders, which was carried out in the infectious diseases department of anesthesiology and intensive care for an average of 5,2±0,7 days. In children in the clinical group, SARS-CoV-2 was verified by reverse transcription polymerase chain reaction of a nasopharyngeal swab and/or exhaled air condensate based on its positive results. Comprehensive treatment of patients with severe and extremely severe respiratory distress syndrome in coronavirus disease included respiratory and hemodynamic support, antiviral and antibacterial therapy, parenteral glucocorticosteroids and anticoagulants, which was in line with current national regulatory guidelines and local protocols. According to the criteria for choosing a method of respiratory function prosthetics, in more than half of the patients (62,2%) with hemoglobin oxygen saturation of less than 92%, while maintaining active respiratory capacity, respiratory support was provided by supplementing humidified oxygen through a face mask or nasal cannulas. In another 29,7% of patients, non-invasive ventilation was performed by constant positive airway pressure, with an oxygenation index of 0,4-0,5 and a positive end-expiratory pressure of 4-5 cm of water column. Children who had a critical course of acute respiratory syndrome caused by coronavirus infection COVID-19 (8,1%) and in whom non-invasive methods of respiratory support did not bring the desired therapeutic result were on invasive ventilation in the mode of auxiliary controlled ventilation or in the mode of synchronized intermittent forced ventilation. It should be noted that children who received respiratory support in the form of non-invasive ventilation by means of constant positive airway pressure required a lower concentration of oxygen in the inhalation mixture compared to patients on free-flow oxygen supplementation. The need for admission to the intensive care unit of children with COVID-19 is primarily associated with respiratory disorders caused by interstitial pneumonia. Oxygen supplementation was of paramount importance in patient management, primarily through noninvasive ventilation with constant positive airway pressure or free flow. The use of a pulmonary protective strategy in the treatment of acute respiratory distress syndrome caused by coronavirus disease COVID-19 in children requiring invasive ventilation was accompanied by a pronounced positive result, as it was not accompanied by side effects and resulted in a rapid recovery of patients.

Effect of Salbutamol on Lung Ventilation in Children with Cystic Fibrosis: Comprehensive Assessment Using Spirometry, Multiple-Breath Washout, and Functional Lung Magnetic Resonance Imaging

Background: Inhalation therapy is one of the cornerstones of the daily treatment regimen in patients with cystic fibrosis (CF). Recommendations regarding the addition of bronchodilators, especially salbutamol are conflicting due to the lack of evidence. New diagnostic measures such as multiple-breath washout (<underline>MBW)</underline> and functional magnetic resonance imaging (MRI) have the potential to reveal new insights into bronchodilator effects in patients with CF. Objective: The objective of the study was to comprehensively assess the functional response to nebulized inhalation with salbutamol in children with CF. Methods: Thirty children aged 6–18 years with stable CF performed pulmonary function tests, MBW, and matrix pencil-MRI before and after standardized nebulized inhalation of salbutamol. Results: Lung clearance index decreased (improved) by −0.24 turnover (95% confidence interval [CI]: −0.53 to 0.06; p = 0.111). Percentage of the lung volume with impaired fractional ventilation and relative perfusion decreased (improved) by −0.79% (CI: −1.99 to 0.42; p = 0.194) and −1.31% (CI: −2.28 to −0.35; p = 0.009), respectively. Forced expiratory volume (FEV₁) increased (improved) by 0.41 z-score (CI: 0.24–0.58; p < 0.0001). We could not identify specific clinical factors associated with a more pronounced effect of salbutamol. Conclusions: There is a positive short-term effect of bronchodilator inhalation on FEV₁ in patients with CF, which is independent of ventilation inhomogeneity. Heterogeneous response between patients suggests that for prediction of a therapeutic effect this should be tested by spirometry in every patient individually.

New aspect of studying the mechanisms of development of the lungs ventilation capacity disorders in children with bronchial asthma

Purpose. Study of the pathogenetic role of the polymorphism of the ACTN3 gene (actinin, alpha 3) rs1815739 in the development of lungs ventilation capacity disorders in children with bronchial asthma.Materials and methods. To study the polymorphism of ACTN3 gene (actinin, alpha 3) rs1815739, the molecular and genetic study of 90 children aged from 6 to 18 years with bronchial asthma, who were passing in-patient treatment at the Allergy Department of the Municipal Non-Profit Enterprise "Children's Hospital no.5" of Zaporizhia City Council, and 25 healthy children (control group) was conducted. The external respiration function was studied using a computer spirograph "PULMOREM" TU U 33.1-02066769-005-2002 (Kharkiv). The study of the polymorphism of the ACTN3 gene (actinin, alpha 3) rs1815739 was performed in the Division of Molecular Genetic Researches of the Training Medical Laboratory Center at the Department of Microbiology of Zaporizhia State Medical University in Zaporizhia on the CFX96TM Real-Time PCR Detection Systems amplifier (Bio-Rad laboratories Inc., USA) with extraction of DNA from venous blood by means of polymerase-chain reaction. The results of the study were processed using statistical analysis of the license software package Statistica for Windows 6.1.RU, serial number AXXR712D833214SAN5.Results. The study of the distribution of allelic genes and genotypes of ACTN3 (actinin, alpha 3) polymorphism for rs1815739 showed that among children with bronchial asthma, the homozygous C/C genotype was recorded in 37.7% of cases, heterozygous C/T genotype in 40% of cases, homozygous T/T genotype in 22.3% of cases, while in healthy children, the frequencies of the homozygous C/C (68%) and T/T (4%) genotypes were significantly more frequent. The indicators of external respiration function (forced vital capacity (FVC), forced expiratory volume at the 1-second (FEV1)) in patients with a homozygous C/C genotype were significantly lower than in patients with homozygous T/T genotype and were 2.69 (1.9; 3.49) vs. 3.11 (2.47; 4, 14) and 2.06 (1.6; 2.76) vs. 2.82 (2.02; 3.51). The patency of large and small bronchi, characterized by spirographic MEF25 and MEF75 indicators, was significantly better in children with bronchial asthma with homozygous T/T genotype than in children with C/T and C/C genotypes (5.46 (4.87; 6, 31) and 2.36 (1.89; 3.32) against 4.54 (3.69; 5.43) and 4. 17 (3.24; 5.44), and 1.88 (1.10; 2.56) and 1.69 (1.16; 2.02), respectively. In children with bronchial asthma and the C/C and C/T genotypes of ACTN3 gene (actinin, alpha 3) rs1815739 with probable sufficient synthesis of alpha-actinin-3 protein in muscles, a stronger contraction of the respiratory muscles on inhalation is possible, and in patients with the T/T genotype, which encodes insufficient synthesis of alpha-actinin-3 protein in the muscles, the muscle contraction is probably less pronounced in asthma attacks, which can lead to less pronounced disorders of lungs ventilation capacity.Conclusions. The study of ACTN3 (actinin, alpha 3) rs1815739 gene polymorphism showed that the C / C and C / T genotypes were associated with impaired lung ventilation in children with bronchial asthma.

Protective Lung Ventilation in Children at Low Risk: Is it Necessary?

Background: Protective ventilation is often used to reduce pulmonary complications and we tested the benefit in paediatrics at low risk during general anaesthesia. Methods: In this randomised controlled trial, we recruited patients who were planned for nonabdominal surgery. Eligible participants were randomly assigned (1:1:1) to receive non-protective ventilation (control group) or low tidal volume with 5 cmH2O positive end-expiratory pressure (PEEP group) or low tidal volume with 5 cmH2O PEEP and recruitment manoeuvres (recruitment group). Lung ultrasonography was undertaken at eight predefined time points. Primary outcome was the difference in lung ultrasonography score and incidence of atelectasis among groups by 24 hours after extubation; a lower score indicates better lung aeration. Findings: Between 25 July 2019-10 January 2020, 90 eligible patients were randomly assigned and included in the final analysis. Atelectasis was the most common pulmonary complication. Patients in the PEEP and recruitment manoeuvre groups showed lower LUS score after the surgical procedure (H = 57.8, P=0.0001) and immediately after extubation (time point T3) (H =18.2, P=0.0001) compared with patients in the control group; However, this difference did not persist 15 min after extubation. Recruitment maneuvers can lead to hemodynamic instability. Interpretation: Aeration loss developed most severe immediately after extubation. Then aeration loss gradually improved and disappeared 3 hours after extubation despite ventilatory strategy. Drawing conclusions regarding the importance of an intraoperative protective ventilation strategy for patients at lower risk of atelectasis is challenging. Trial Registration: This study is registered with the Chinese Clinical Trial Registry (#ChiCTR1800018912). Funding Statement: None. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was approved by the research ethics boards of Shanghai Children's Hospital (protocol number: 2019R044-F01, 24July 2019. Written informed consent was obtained from all participants.

Сравнительный анализ режимов искусственной вентиляции легких у детей раннего возраста с дыхательной недостаточностью на фоне бронхолегочной дисплазии.

Сравнительный анализ режимов искусственной вентиляции легких у детей раннего возраста с дыхательной недостаточностью на фоне бронхолегочной дисплазии.

Differential lung ventilation via tracheostomy using two endotracheal tubes in an infant: a case report

BackgroundThis case report presents differential lung ventilation in an infant. The aim is to define an alternative technique for performing differential lung ventilation in children. To the best of our knowledge, this is the first report of this kind.Case presentationA 4.2-kg, 2.5-month-old Asian boy was referred to our facility with refractory hypoxemia and hypercarbia due to asymmetric lung disease with atelectasis of the left lung and hyperinflation of the right lung. He was unresponsive to conventional ventilator strategies; different ventilator settings were required. To perform differential lung ventilation, two separate single-lumen endotracheal tubes were inserted into the main bronchus of each lung by tracheotomy; the tracheal tubes were attached to discrete ventilators. The left lung was ventilated with a lung salvage strategy using high-frequency oscillatory ventilation, and the right lung was ventilated with a lung-protective strategy using pressure-regulated volume control mode. Differential lung ventilation was performed successfully with this technique without complications.ConclusionsDifferential lung ventilation may be a lifesaving procedure in select patients who have asymmetric lung disease. Inserting two single-lumen endotracheal tubes via tracheotomy for differential lung ventilation can be an effective and safe alternative method.

Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial.

One lung ventilation (OLV) results in inflammatory and mechanical injury, leading to intraoperative and postoperative complications in children. No interventions have been studied in children to minimize such injury. We hypothesized that a single 2-mg·kg(-1) dose of methylprednisolone given 45-60min prior to lung collapse would minimize injury from OLV and improve physiological stability. Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2mg·kg(-1) methylprednisolone (MP) or normal saline (placebo group) prior to OLV. Anesthetic management was standardized, and data were collected for physiological stability (bronchospasm, respiratory resistance, and compliance). Plasma was assayed for inflammatory markers related to lung injury at timed intervals related to administration of methylprednisolone. Three children in the placebo group experienced clinically significant intraoperative and postoperative respiratory complications. Respiratory resistance was lower (P=0.04) in the methylprednisolone group. Pro-inflammatory cytokine IL-6 was lower (P=0.01), and anti-inflammatory cytokine IL-10 was higher (P=0.001) in the methylprednisolone group. Tryptase, measured before and after OLV, was lower (P=0.03) in the methylprednisolone group while increased levels of tryptase were seen in placebo group after OLV (did not achieve significance). There were no side effects observed that could be attributed to methylprednisolone in this study. Methylprednisolone at 2mg·kg(-1) given as a single dose prior to OLV provides physiological stability to children undergoing OLV. In addition, methylprednisolone results in lower pro-inflammatory markers and higher anti-inflammatory markers in the children's plasma.

Monitoring of Regional Lung Ventilation Using Electrical Impedance Tomography After Cardiac Surgery in Infants and Children

Electrical impedance tomography (EIT) is a noninvasive method to monitor regional lung ventilation in infants and children without using radiation. The objective of this prospective study was to determine the value of EIT as an additional monitoring tool to assess regional lung ventilation after pediatric cardiac surgery for congenital heart disease in infants and children. EIT monitoring was performed in a prospective study comprising 30 pediatric patients who were mechanically ventilated after cardiac surgery. Data were analyzed off-line with respect to regional lung ventilation in different clinical situations. EIT data were correlated with respirator settings and arterial carbon dioxide (CO2) partial pressure in the blood. In 29 of 30 patients, regional ventilation of the lung could sufficiently and reliably be monitored by means of EIT. The effects of the transition from mechanical ventilation to spontaneous breathing after extubation on regional lung ventilation were studied. After extubation, a significant decrease of relative impedance changes was evident. In addition, a negative correlation of arterial CO2 partial pressure and relative impedance changes could be shown. EIT was sufficient to discriminate differences of regional lung ventilation in children and adolescents after cardiac surgery. EIT reliably provided additional information on regional lung ventilation in children after cardiac surgery. Neither chest tubes nor pacemaker wires nor the intensive care unit environment interfered with the application of EIT. EIT therefore may be used as an additional real-time monitoring tool in pediatric cardiac intensive care because it is noninvasive.

Airway management techniques for one lung ventilation in children - what else!

Airway management techniques for one lung ventilation in children - what else!

Experience with the Arndt paediatric bronchial blocker

Previously reported techniques for single lung ventilation in children have failed to provide consistent, single lung ventilation with relative ease and reliability. We report our experience with the use of a new device, the Arndt 5 French (Fr) paediatric endobronchial blocker, for single lung ventilation in a series of 24 children. We were able to achieve single lung ventilation in 23 of the 24 patients (aged 2-16 yr). Placement required approximately 5-15 min. Attempts at placement were aborted in one patient who was unable to tolerate even short periods of apnoea because of lung pathology. Although it has some limitations, our experience suggests that the paediatric bronchial blocker can be used as a consistent, safe method of single lung ventilation in most young children.