PT  - JOURNAL ARTICLE
AU  - Kheir, John N
AU  - Walsh, Brian K
AU  - Smallwood, Craig D
AU  - Rettig, Jordan S
AU  - Thompson, John E
AU  - Gómez-Laberge, Camille
AU  - Wolf, Gerhard K
AU  - Arnold, John H
TI  - Comparison of Two Lung Recruitment Strategies in Children with Acute Lung
AID  - 10.4187/respcare.01808
DP  - 2012 Dec 04
TA  - Respiratory Care
PG  - respcare.01808
4099  - http://rc.rcjournal.com/content/early/2012/12/04/respcare.01808.short
4100  - http://rc.rcjournal.com/content/early/2012/12/04/respcare.01808.full
AB  - Background. Lung recruitment maneuvers are frequently used in the treatment of children with lung injury. Here, we describe a pilot study to compare the acute effects of two commonly used lung recruitment maneuvers on lung volume, gas exchange and hemodynamic profiles in children with acute lung injury (ALI). Methods. In a prospective, non-randomized, cross-over pilot study, n=10 intubated pediatric patients with lung injury sequentially underwent (1) a period of observation, (2) a sustained inflation (SI) maneuver of 40 cm H2O for 40 seconds and open lung ventilation, (3) a staircase recruitment strategy (SRS) which utilized 5 cm H2O increments in airway pressure from a starting plateau pressure of 30 cm H2O and PEEP of 15 cm H2O, (4) a downwards PEEP titration and (5) a one hour period of observation with PEEP set 2 cm H2O above closing PEEP. Results. Arterial blood gases, lung mechanics, hemodynamics and functional residual capacity were recorded following each phase of the study and following each increment of the SRS. Both SI and SRS were effective in raising arterial oxygen tension and functional residual capacity. During the SRS maneuver, we noted significant increases in dead space ventilation, a decrease in CO2 elimination, an increase in arterial carbon dioxide tension and a decrease in compliance of the respiratory system (Crs). Lung recruitment was not sustained following the decremental PEEP titration. Conclusions. SRS is effective in opening the lung in children with early ALI, and is hemodynamically well tolerated. However, attention must be paid to carbon dioxide tension during the SRS. Even minutes following lung recruitment, lungs may derecruit when PEEP is lowered beyond the closing pressure.