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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2016

Open Access 01-12-2016 | Research

Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome

Authors: Davide Chiumello, Giovanna Chidini, Edoardo Calderini, Andrea Colombo, Francesco Crimella, Matteo Brioni

Published in: Annals of Intensive Care | Issue 1/2016

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Abstract

Background

In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. However, no major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity).

Methods

The end-expiratory lung volume was measured using a simplified closed circuit helium dilution method. During an inspiratory and expiratory pause, the airway and esophageal pressure were measured. Transpulmonary pressure was computed as the difference between airway and esophageal pressure.

Results

Ten intubated sedated paralyzed healthy children and ten children with ARDS underwent a PEEP trial (4 and 12 cmH2O) with a tidal volume of 8, 10 and 12 ml/kgIBW. The two groups were comparable for age and BMI (2.5 [1.0–5.5] vs 3.0 [1.7–7.2] years and 15.1 ± 2.4 vs 15.3 ± 3.0 kg/m2). The functional residual capacity in ARDS patients was significantly lower as compared to the control group (10.4 [9.1–14.3] vs 16.6 [11.7–24.6] ml/kg, p = 0.04). The ARDS patients had a significantly lower respiratory system and lung compliance as compared to control subjects (9.9 ± 5.0 vs 17.8 ± 6.5, 9.3 ± 4.9 vs 16.9 ± 4.1 at 4 cmH2O of PEEP and 11.7 ± 5.8 vs 23.7 ± 6.8, 10.0 ± 4.9 vs 23.4 ± 7.5 at 12 cmH2O of PEEP). The compliance of the chest wall was similar in both groups (76.7 ± 30.2 vs 94.4 ± 76.4 and 92.6 ± 65.3 vs 90.0 ± 61.7 at 4 and 12 cmH2O of PEEP). The lung stress and strain were significantly higher in ARDS patients as compared to control subjects and were poorly related to airway pressure and tidal volume normalized for body weight.

Conclusions

Airway pressures and tidal volume normalized to body weight are poor surrogates for lung stress and strain in mild pediatric ARDS.
Trial registration: Clinialtrials.gov NCT02036801. Registered 13 January 2014
Appendix
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Literature
1.
Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2015;16:428–39.
2.
De Luca D, Piastra M, Chidini G, Tissieres P, Calderini E, Essouri S, Medina Villanueva A, Vivanco Allende A, Pons-Odena M, Perez-Baena L, Hermon M, Tridente A, Conti G, Antonelli M, Kneyber M. Respiratory Section of the European Society for Pediatric Neonatal Intensive Care (ESPNIC): The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus. Intensive Care Med. 2013;39:2083–91.CrossRefPubMed
3.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307:2526–33.
4.
Zimmerman JJ, Akhtar SR, Caldwell E, Rubenfeld GD. Incidence and outcomes of pediatric acute lung injury. Pediatrics. 2009;124:87–95.CrossRefPubMed
5.
Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, Wilkins B, Paediatric Study Group, Australian and New Zealand Intensive Care Society. Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2007;8:317–23.
6.
7.
Yu W-L, Lu Z-J, Wang Y, Shi L-P, Kuang F-W, Qian S-Y, Zeng Q-Y, Xie M-H, Zhang G-Y, Zhuang D-Y, Fan X-M, Sun B. Collaborative Study Group of Pediatric Respiratory Failure: the epidemiology of acute respiratory distress syndrome in pediatric intensive care units in China. Intensive Care Med. 2009;35:136–43.CrossRefPubMed
8.
López-Fernández Y, Azagra AM, de la Oliva P, Modesto V, Sánchez JI, Parrilla J, Arroyo MJ, Reyes SB, Pons-Ódena M, López-Herce J, Fernández RL, Kacmarek RM, Villar J. Pediatric Acute Lung Injury Epidemiology and Natural History (PED-ALIEN) Network: pediatric acute lung injury epidemiology and natural history study: incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med. 2012;40:3238–45.CrossRefPubMed
9.
Khemani RG, Conti D, Alonzo TA, Bart RD, Newth CJL. Effect of tidal volume in children with acute hypoxemic respiratory failure. Intensive Care Med. 2009;35:1428–37.CrossRefPubMed
10.
Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA. 2010;303:865–73.CrossRefPubMed
11.
Flori HR, Glidden DV, Rutherford GW, Matthay MA. Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality. Am J Respir Crit Care Med. 2005;171:995–1001.CrossRefPubMed
12.
Bojko T, Notterman DA, Greenwald BM, De Bruin WJ, Magid MS, Godwin T. Acute hypoxemic respiratory failure in children following bone marrow transplantation: an outcome and pathologic study. Crit Care Med. 1995;23:755–9.CrossRefPubMed
13.
Dahlem P, van Aalderen WMC, Hamaker ME, Dijkgraaf MGW, Bos AP. Incidence and short-term outcome of acute lung injury in mechanically ventilated children. Eur Respir J. 2003;22:980–5.CrossRefPubMed
14.
Randolph AG. Management of acute lung injury and acute respiratory distress syndrome in children. Crit Care Med. 2009;37:2448–54.CrossRefPubMed
15.
de Jager P, Burgerhof JGM, van Heerde M, Albers MJIJ, Markhorst DG, Kneyber MCJ. Tidal volume and mortality in mechanically ventilated children: a systematic review and meta-analysis of observational studies*. Crit Care Med. 2014;42:2461–72.CrossRefPubMed
16.
Numa AH, Hammer J, Newth CJ. Effect of prone and supine positions on functional residual capacity, oxygenation, and respiratory mechanics in ventilated infants and children. Am J Respir Crit Care Med. 1997;156(4 Pt 1):1185–9.CrossRefPubMed
17.
Sivan Y, Deakers TW, Newth CJ. Functional residual capacity in ventilated infants and children. Pediatr Res. 1990;28:451–4.CrossRefPubMed
18.
Sivan Y, Deakers TW, Newth CJ. Effect of positive end-expiratory pressure on respiratory compliance in children with acute respiratory failure. Pediatr Pulmonol. 1991;11:103–7.CrossRefPubMed
19.
Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, Tallarini F, Cozzi P, Cressoni M, Colombo A, Marini JJ, Gattinoni L. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346–55.CrossRefPubMed
20.
Protti A, Cressoni M, Santini A, Langer T, Mietto C, Febres D, Chierichetti M, Coppola S, Conte G, Gatti S, Leopardi O, Masson S, Lombardi L, Lazzerini M, Rampoldi E, Cadringher P, Gattinoni L. Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med. 2011;183:1354–62.CrossRefPubMed
21.
Chiumello D, Cressoni M, Colombo A, Babini G, Brioni M, Crimella F, Lundin S, Stenqvist O, Gattinoni L. The assessment of transpulmonary pressure in mechanically ventilated ARDS patients. Intensive Care Med. 2014;40(11):1670–8CrossRefPubMed
22.
Pelosi P, Cereda M, Foti G, Giacomini M, Pesenti A. Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Respir Crit Care Med. 1995;152:531–7.CrossRefPubMed
23.
Kneyber MCJ, Zhang H, Slutsky AS. Ventilator-induced lung injury. Similarity and differences between children and adults. Am J Respir Crit Care Med. 2014;190:258–65.PubMed
24.
Papastamelos C, Panitch HB, England SE, Allen JL. Developmental changes in chest wall compliance in infancy and early childhood. J Appl Physiol Bethesda Md. 1985;1995(78):179–84.
25.
Papastamelos C, Panitch HB, Allen JL. Chest wall compliance in infants and children with neuromuscular disease. Am J Respir Crit Care Med. 1996;154(4 Pt 1):1045–8.CrossRefPubMed
26.
Kornecki A, Tsuchida S, Ondiveeran HK, Engelberts D, Frndova H, Tanswell AK, Post M, McKerlie C, Belik J, Fox-Robichaud A, Kavanagh BP. Lung development and susceptibility to ventilator-induced lung injury. Am J Respir Crit Care Med. 2005;171:743–52.CrossRefPubMed
27.
Caironi P, Langer T, Carlesso E, Protti A, Gattinoni L. Time to generate ventilator-induced lung injury among mammals with healthy lungs: a unifying hypothesis. Intensive Care Med. 2011;37:1913–20.CrossRefPubMed
28.
Nisbet HI, Levison H, Pelton DA. Static thoracic compliance in normal children under general anaesthesia. Acta Anaesthesiol Scand. 1971;15:179–91.CrossRefPubMed
29.
Zapletal A, Paul T, Samanek M. Pulmonary elasticity in children and adolescents. J Appl Physiol. 1976;40:953–61.PubMed
30.
Baran D, Yernault JC, Paiva M, Englert M. Static mechanical lung properties in healthy children. Scand J Respir Dis. 1976;57:139–47.PubMed
31.
Tepper RS, Williams T, Kisling J, Castile R. Static compliance of the respiratory system in healthy infants. Am J Respir Crit Care Med. 2001;163:91–4.CrossRefPubMed
32.
Ingimarsson J, Thorsteinsson A, Larsson A, Werner O. Lung and chest wall mechanics in anesthetized children. Influence of body position. Am J Respir Crit Care Med. 2000;162(2 Pt 1):412–7.CrossRefPubMed
33.
Gerhardt T, Hehre D, Feller R, Reifenberg L, Bancalari E. Pulmonary mechanics in normal infants and young children during first 5 years of life. Pediatr Pulmonol. 1987;3:309–16.CrossRefPubMed
34.
35.
Sharp JT, Druz WS, Balagot RC, Bandelin VR, Danon J. Total respiratory compliance in infants and children. J Appl Physiol. 1970;29:775–9.PubMed
36.
Fletcher ME, Stocks J, Ridley S, Braude N, Yates AP, Hatch DJ. Total respiratory compliance during anaesthesia in infants and young children. Br J Anaesth. 1989;63:266–75.CrossRefPubMed
37.
38.
von Ungern-Sternberg BS, Hammer J, Schibler A, Frei FJ, Erb TO. Decrease of functional residual capacity and ventilation homogeneity after neuromuscular blockade in anesthetized young infants and preschool children. Anesthesiology. 2006;105:670–5.CrossRef
39.
Colin AA, Wohl ME, Mead J, Ratjen FA, Glass G, Stark AR. Transition from dynamically maintained to relaxed end-expiratory volume in human infants. J Appl Physiol Bethesda Md. 1985;1989(67):2107–11.
40.
Fisher JT, Mortola JP, Smith JB, Fox GS, Weeks S. Respiration in newborns: development of the control of breathing. Am Rev Respir Dis. 1982;125:650–7.PubMed
Metadata
Title
Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome
Authors
Davide Chiumello
Giovanna Chidini
Edoardo Calderini
Andrea Colombo
Francesco Crimella
Matteo Brioni
Publication date
01-12-2016
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2016
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-016-0113-0

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