The Use of Lung Mechanics to Identify the Optimal Level of Positive End-Expiratory Pressure in Mechanically Ventilated Children with Acute Lung Injury

Kruse, L. (Lilia) (2015) The Use of Lung Mechanics to Identify the Optimal Level of Positive End-Expiratory Pressure in Mechanically Ventilated Children with Acute Lung Injury. thesis, Medicine.

Text KruseL.pdf Restricted to Registered users only Download (2MB)

Abstract

Background: Acute lung injury (ALI) is characterized by an inflammatory response to local pulmonary or systemic insults resulting in hypoxemia and respiratory failure. Although the mainstay management of ALI is respiratory support, this has shown to be complicated by ventilator-induced lung injury (VILI). In order to transcend these adverse effects, positive end-expiratory pressure (PEEP), a novel attribute of mechanical ventilation is commonly applied, allowing for an increase in functional residual capacity (FRC) and oxygenation by decreasing the amount of ventilation-perfusion mismatch. Despite the general consensus on the benefits of PEEP, procedure-related aspects remain a topic of ongoing debate. Here, controversy remains on the optimal level of PEEP to provide favourable outcomes while minimizing the amount of injurious impact. Objective: To determine the optimal PEEP by studying the level and time-course of the end-expiratory lung volume. Furthermore, the relationship between end-expiratory lung volume and the level and time course of the oxygenation index, respiratory system compliance, lung compliance, transpulmonary pressure, and exploring the alveolar dead space fraction. Methodology: PEEP values of mechanically ventilated children with viral pneumonia were increased by 2 cm H2O every 3-5 minutes from a baseline of 4 cmH20 to a maximum value of 20 cmH2O. Upon reaching the maximum value, the PEEP value was decreased in the same manner until baseline value was reached or until oxygen saturation decreased more than 10%. End-expiratory lung volume as well as other parameters were be measured and recorded after each PEEP step. Data was analyzed using SPSS and Prism Graphpad. Results: Five patients with viral pneumonia were recruited. Higher PEEP levels significantly increased the PaCO2, EtCO2, Valv, Vd/Vt, Pmean, and Ptp-plat and decreased the SpO2, suggesting that lower PEEP values may be preferred in this particular patient population. Conclusion: Higher PEEP levels do have significant negative effects on mechanically ventilated pediatric patients with viral pneumonia.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervised by and Kneyber, Dr. Martin and Department of Pediatric Intensive Care Medicine and Universitair Medisch Centrum Groningen
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:42
Last Modified:	25 Jun 2020 10:42
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/353

Actions (login required)

View Item