title: Distribution and pathophysiology of acute lobar collapse in the pediatric intensive care unit.
abstract: OBJECTIVE
  The high incidence of lower lobe collapse in adult intensive care patients is well described. We aimed to document the incidence and distribution of acute lobar collapse in the pediatric intensive care setting. The influence of anatomical and pathophysiological differences between the adult and pediatric respiratory tract will be considered.
  
  
  METHODS
  Retrospective review of chest radiograph series.
  
  
  METHODS
  Tertiary referral center for pediatric intensive care and the Department of Diagnostic Radiology in a large teaching hospital in England.
  
  
  METHODS
  Cohort of 160 patients receiving intensive care during a 2-yr period (age range, 6 days-18 yrs; median, 23 months).
  
  
  METHODS
  None
  
  
  RESULTS
  Twenty-four of 160 children (15%) developed acute lobar collapse during their intensive care unit admission. Isolated right upper lobe collapse occurred in 14 patients, right upper lobe in association with one or more other lobes in five patients, and lobar collapse other than the right upper lobe in five patients. The development of lobar collapse and, in particular, right upper lobe collapse was associated with a lower median age (no collapse, 26 months; lobar collapse, 8 months; right upper lobe collapse, 4 months). Lobar collapse was significantly associated with the requirement for mechanical ventilation during admission (chi-square, 12.18; p = .005). It was observed in association with both high and low endotracheal tube positions.
  
  
  CONCLUSIONS
  The predominance of upper lobe and, in particular, right upper lobe collapse observed in pediatric intensive care patients contrasts with the high incidence of lower lobe collapse in their adult counterparts. Multiple interrelated factors are likely to be contributory and include the following: a) anatomical and physiological differences between adults and children; b) the pathophysiology of childhood respiratory disease; c) more critical positioning of endotracheal tubes in younger patients and their movement with patient positioning.
authors.affiliation: Department of Diagnostic Radiology, St. Mary's Hospital Medical School, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Thomas
authors.forename: P
authors.initials: P
authors.lastname: Habibi
authors.forename: J
authors.initials: J
authors.lastname: Britto
authors.forename: C M
authors.initials: CM
authors.lastname: Owens
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control; D011859:Radiography; D012121:Respiration, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016683:Supine Position