[Clinical analysis of recruitment maneuver with low tidal volume in the treatment of 15 children with acute lung injury]

Abstract

Objective: To determine the effects and feasibility of recruitment maneuver (RM) on children with acute lung injury (ALI), and to establish a more reasonable ventilation strategy in the treatment of pediatric ALI.

Method: A prospective physiologic study was conducted in the Pediatric Intensive Care Unit (PICU). Fifteen consecutive eligible pediatric patients with ALI according to the 1994 AECC definition were enrolled in this study. The children received the ventilation of RM with low tidal volume. The clinician administered RM was performed at 30 cm H2O continuous positive airway pressure (CPAP) for 30 seconds. RMs were conducted once every eight hours for five days. Data on gas exchange, lung mechanics and hemodynamics from pre-RM to post-RM (at 5, 15, 30 and 60 min) was recorded at the first, third and fifth day. To monitor the pathogenic conditions of children, the radiographic examination was rechecked for every child within one week. At last, we documented the mortality and the length of ventilation of every patient.

Result: On the first, third and fifth day, the P/F ratio of the patients was 243.8 mm Hg, 281.8 mm Hg and 309.9 mm Hg respectively, and significant improvements in oxygenation were demonstrated post-RM compared to pre-RM (P < 0.01). Cdyn [0.762 ml/(cm H2O×kg), 0.835 (ml/cm H2O×;kg), 0.928 ml/(cm H2O×kg)] before RMs also showed increase in the children on the first, third and fifth day (P < 0.01). Though there were some changes in blood pressure and heart rate following RM, no statistically significant changes were found during the course of RM. During the entire study of 5 days, all the 11 subjects whose chest radiograph showed infiltration had improvements, the length of ventilation was (10.15 ± 4.3) d.

Conclusion: RM can significantly improve the oxygenation and attenuate the deterioration in pulmonary function in treatment for pediatric ALI and improve the lung compliance. It is safe and feasible.