Clinical Feature And Lung Recruitment Maneuver In Pediatric Acute Respiratory Distress Syndrome

Objective: To evaluate the efficacy and safety of a recruitment maneuver, in pediatric patients with acute respiratory distress syndrome.Methods: To January 1, 2013- January 1, 2015 Hunan Children’s Hospital PICU stay of all patients after discharge into the PCIS and American PICU guide screened critically ill children as the same period the prevalence of children with ARDS base. 21 mechanical ventilated patients with acute respiratory distress syndrome(ARDS) were selected and by parental consent for this study. implemented within 72 hours of admission lung recruitment strategies, Lung Recruitment maneuvers(LRM) were performed with PEEP stepwise, set inspiratory pressure limit for 45cmH2 O, PEEP values will rise at a constant speed of every 30 s 5cmH2O the rate of increase to the suction pressure limits and maintain the upper limit 30 s. Then every 30 s down to the level of recruitment uniform before 5cmH2 O, restore the original ventilator mode and parameter values. And clinical data were collected prospectively. Before all the children at the time of diagnosis ARDS, pulmonary reexpansion implementation, after lung recruitment 10 Min, after lung recruitment 4hr, 12 hr collected after lung recruitment arterial blood gas, record the children breathing, heart rate, blood pressure, transcutaneous oxygen saturation, inspired oxygen concentration, PEEP, peak inspiratory pressure, lung dynamic compliance and other relevant indicators and to assess lung recruitment maneuver’s efficacy and safety.Results:1、 This study conforms to the conditions of children with ARDS a total of 21 cases were within 1 week of the onset, primary disease with pneumonia ranks first, pus sepsis times, 21 cases of children with chest X-ray showed two to three quadrant infiltrates in both lungs; severe in children with acute respiratory distress syndrome(ARDS) majority.2、 Effect of the Lung Recruitment Maneuver on Oxygenation. The PaO2/FiO2 ratio increased 53% immediately after the RM( P<0.01). Improvement in Pa O2/FiO2 ratio persisted with an increase of 80% over the baseline at 4 hrs(P<0.05) and 40%.at 12 hrs after the RM(P<0.01).The alveoloarterial oxygenation gradient decreased by 12% immediately after the RM(P<0.01), by 59% at 4 hrs, and by 66% at 12 hrs after the RM(P<0.01). Compared with baseline, the oxygenation index improved by 24% immediately after the RM(P<0.05) and by 31% at 4 hrs after the RM(P<0.05).3、 Effect of the RM on Ventilation. Compared with baseline, the PaCO24、 was not significantly changed immediately after the RM and 12 hrs after the RM, but it was significantly decreased 4 hrs post-RM(P<0.01).5、 Effect of the RM on Respiratory Variables. Peak inspiratory pressure decreased by 17% below the baseline at 4 hrs and 12 hrs after the RM(p<0.05)Fraction of inspired oxygen was not significantly changed at 4 hrs and 12 hrs after the RM. Dynamic compliance and mean airway pressure were not significantly changed after the RM.6、 Safety. All patients tolerated the RM without hemodynamic compromise(hypotension and/or bradycardia). We found no statistically significant difference in heart rate at selected time points during the RM compared with pre-RM. We found a statistically sigdemonstrated early and lasting improvement in oxygenation up to 12 hrs after a RM in pediatric patients with ALI. Recruitment maneuvers were well tolerated except for significant increase in PaCO2 in three patients. There were no serious adverse events related to the recruitment maneuver.Conclusions: The Berlin definition of ARDS clinical characteristics of children with: to within 1 week of the onset, primary disease with pneumonia ranks first, pus poisonous disease second, chest X-ray showed two to three quadrant infiltrates in both lungs. Using the recruitment maneuver during lung prottected ventilation, pediatric patients with acute respiratory distress syndrome, may safely achieve improves oxygenation persisting up to 12 hrs after the recruitment maneuver and has no clinically significant effect on ventilation and is safe and well tolerated.