Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end-expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease.
OBJECTIVE
Optimizing alveolar recruitment by alveolar recruitment strategy (ARS) and maintaining lung volume with adequate positive end-expiratory pressure (PEEP) allow preventing ventilator-induced lung injury (VILI). Knowing that PEEP has its most beneficial effects when dynamic compliance of respiratory system (Crs) is maximized, we hypothesize that the use of 8 cm H(2)O PEEP with ARS results in an increase in Crs and end-expiratory lung volume (EELV) compared to 8 cm H(2)O PEEP without ARS and to zero PEEP in pediatric patients undergoing cardiac surgery for congenital heart disease.


METHODS
Twenty consecutive children were studied. Three different ventilation strategies were applied to each patient in the following order: 0 cm H(2)O PEEP, 8 cm H(2)O PEEP without an ARS, and 8 cm H(2)O PEEP with a standardized ARS. At the end of each ventilation strategy, Crs, EELV, and arterial blood gases were measured.


RESULTS
EELV, Crs, and P(a)O(2)/FiO(2) ratio changed significantly (P < 0.001) with the application of 8 cm H2O + ARS. Mean P(a)CO(2)- PETCO(2) difference between 0 PEEP and 8 cm H2O PEEP + ARS was also significant (P < 0.05).


CONCLUSIONS
An alveolar recruitment strategy with relative high PEEP significantly improves Crs, oxygenation, P(a)CO(2)- PETCO(2) difference, and EELV in pediatric patients undergoing cardiac surgery for congenital heart disease.
Scohy
Thierry V
TV
Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands. t.scohy@erasmusmc.nl
Bikker
Ido G
IG
Hofland
Jan
J
de Jong
Peter L
PL
Bogers
Ad J J C
AJ
Gommers
Diederik
D
D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D008170:Lung Compliance; D055370:Lung Injury / Q000517:prevention & control; D008176:Lung Volume Measurements / Q000379:methods; D008297:Male; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods; D011650:Pulmonary Alveoli / Q000502:physiology*; D011659:Pulmonary Gas Exchange; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000379:methods*; D016896:Treatment Outcome
D010100:Oxygen