| Objective:Acute lung injury (ALI), acute respiratory distress syndrome (ARDS) and neonatal respiratory distress syndrome (NRDS) are the most critical diseases and seriously endanger children's lives in pediatrics. These diseases are often seen in pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU). Many medical therapies in ALI/ARDS and NRDS are effective and mechanical ventilation is one of the most important methods to treat ALI/ARDS and NRDS. Low tidal volume ventilation is a protective strategy, as it can avoid the high ventilation parameters of the conventional mechanical ventilation. So it is necessary to study good values on the treatment in ALI/ARDS and NRDS by low tidal volume ventilation and fluid management. The main purpose of this study is to explore the differences in ventilation time, length of stay in hospital, complicated incidences and mortalities between two groups patients with ALI/ARDS or NRDS, in which one group patients were treated by low tidal volume ventilation and fluid management, the other group patients were treated by conventional tidal volume ventilation and conventional fluid infusion.Subjects and methods:1. Observing subjects:Ninety-five patients with ALI/ARDS or NRDS were enrolled in this study from November 2005 to October 2009 in Kunming Children's Hospital and they were met the admissive criteria which made for this study. The patients were divided into two groups:Forty-nine cases in the treatment group and forty-six cases in the control group, but the data of control group were retrospective.2. Methods:All patients chosen were intubated via mouth and ventilated by mechanical ventilator besides their primary diseases and complications were treated. Mechanical ventilation modes, such as assisted/controlled ventilation or synchronized intermittent mandatory ventilation plus pressure support ventilation, etc, were chosen according the patients'situations.60%～100% O2 was used as the initial fraction of inspired oxygen and turned down 40% depending on the patients' situations after 4～6 hours.40% O2 was used as the initial fraction of inspired oxygen with premature infants and turned up or down according to the patients'situations and results of blood gas. Respiratory rates were adjusted according to age:newborns ranged at 35～40 per minute, young children ranged at 25～35 per minute and children ranged at 20～25 per minute. The patients of control group were received conventional ventilation:the higher parameters of ventilation (PIP, PEEP, MAP, I:E, FiO2), to keep tidal volume in the range of 10-15ml/kg, PH in the range of 7.35～7.45, PO2 in the range of 60～100 mmHg and PCO2 in the range of 35～45 mmHg. Whereas for the patients of treatment group:tidal volume was chosen in the range of 5-7 ml/kg and 4～5ml/kg with the newborn; I:E changes were adjusted in the range of 1:1～2 or inspiratory time at rang of 0.4～0.5 second; PIP≤30cmH2O (Pressure-controlled) or MAP≤30cmH2O (Volume-controlled); PEEP depending on pressure volume curve, it was at lower inflate point and was chosen in the range of 4-6 cmH2O generally. The results of blood gas were accepted:7.20≤PH≤7.45, 55≤PaO2≤80mmHg or 88%≤SPO2≤95%, 35≤PaCO2≤55mmHg. On strategy of fluid management, the patients of control group were received conventional fluid, whereas for the patients of treatment group were received fluid management, those was 70～80% of conventional fluid infusion in the. fist 7 days. Infusion rate was adjusted according to patients' cardiac function, electrolyte (salt) metabolism and energy metabolism freely and it usually less than 4ml/kg per hour to keep homeostatic equilibrium. Except tidal volume ventilation and fluid management, the treatment prescriptions of patients in two groups were same.3. Monitoring items:Recording the numerical values of blood gas before mechanical ventilation and at 24 hours,48 hours 72 hours after mechanical ventilation and monitoring ventilation time, length of stay in hospital, complicated incidences and mortalities.4. Statistical analyses:Test data were analyzed using SPSS statistic software (version 13.0). A p value less then 0.05 was considered statistically significant.Results:1. Comparing the numerical values of blood gas of two groups:Before mechanical ventilation they were no significant (P>0.05) on PH,PaO2,PaCO2. After mechanical ventilation 24 hours:There were significant differences(P<0.05) on PH,PaO2,PaCO2,between two groups; 72 hours:They were no significant (P>0.05) on PH,PaO2,PaCO2 again.2. Comparing the ventilation time and the length of stay in hospital of two groups:Ventilation time:The control group 8.2±2.7 days, and the treatment group 6.7±3.2 days. There was significant decrease (P<0.05). Length of stay in hospital:The control group 25.1±6.1 days, and the treatment group 23.1±5.6 days. There was no significant change (P>0.05).3. Comparing the complicated incidences and the mortalities of two groups:Complicated incidences:The control group 12 cases, including air leak 6 cases, ventilator-associated pneumonia 6 cases; The treatment group 5 cases, including air leak 1 cases, ventilator-associated pneumonia 4 cases. There was significant decrease (P<0.05). Mortalities:The control group 18 cases and the treatment group 10 cases. There was significant decrease (P <0.05).Conclusion:Through the low tidal volume ventilation and fluid management treatment in ALI/ARDS and NRDS, that is better than conventional tidal volume ventilation and conventional fluid infusion. Because it can reduce the complicated incidences and mortalities, meanwhile, it can shorten the time of mechanical ventilation. So this therapeutic method on ALI/ARDS and NRDS should be adopted. |
