Minimal Change in Cardiac Index With Increasing PEEP in Pediatric Acute Respiratory Distress Syndrome

Frontiers in Pediatrics

article

Manpreet K. Virk¹  Justin C. Hotz²  Wendy Wong³  Robinder G. Khemani²  Christopher J. L. Newth²  Patrick A. Ross² 

[1] Section of Critical Care, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, United States;Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, United States;Critical Care Medicine, Valley Children's Hospital, United States

关键词: positive end-expiratory pressure;    acute respiratory distress syndrome;    mechanical ventilation;    cardiac index;    stroke volume;   

DOI  :  10.3389/fped.2019.00009

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Objective: To determine if increasing positive end expiratory pressure (PEEP) leads to a change in cardiac index in children with Pediatric Acute Respiratory Distress Syndrome ranging from mild to severe. Design: Prospective interventional study. Setting: Multidisciplinary Pediatric Intensive Care Unit in a University teaching hospital. Patients: Fifteen intubated children (5 females, 10 males) with a median age of 72 months (IQR 11, 132) and a median weight of 19.3 kg (IQR 7.5, 53.6) with a severity of Pediatric Acute Respiratory Distress Syndrome that ranged from mild to severe with a median lung injury score of 2.3 (IQR 2.0, 2.7). Measurements: Cardiac index (CI) and stroke volume (SV) were measured on baseline ventilator settings and subsequently with a PEEP 4 cmH 2 O higher than baseline. Change in CI and SV from baseline values was evaluated using Wilcoxon signed rank test. Results: A total of 19 paired measurements obtained. The median baseline PEEP was 8 cmH 2 O (IQR 8, 10) Range 6–14 cmH 2 O. There was no significant change in cardiac index or stroke volume with change in PEEP. Baseline median CI 4.4 L/min/m 2 (IQR 3.4, 4.8) and PEEP 4 higher median CI of 4.3 L/min/m 2 (IQR 3.6, 4.8), p = 0.65. Baseline median SV 26 ml (IQR 13, 44) and at PEEP 4 higher median SV 34 ml (IQR 12, 44) p = 0.63. Conclusion: There is no significant change in cardiac index or stroke volume with increasing PEEP by 4 cmH 2 O in a population of children with mild to severe PARDS. Clinical Trial Registration: The study is registered on Clinical trails.gov under the Identifier: {"type":"clinical-trial","attrs":{"text":"NCT02354365","term_id":"NCT02354365"}} NCT02354365 .

【 授权许可】

CC BY