Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation
Abstract Background Titration of the continuous distending pressure during a staircase incremental–decremental pressure lung volume optimization maneuver in children on high-frequency oscillatory ventilation is traditionally driven by oxygenation and hemodynamic responses, although validity of these...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-11-01
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| Series: | Annals of Intensive Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00771-8 |
| _version_ | 1818401141500674048 |
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| author | Pauline de Jager Johannes G. M. Burgerhof Alette A. Koopman Dick G. Markhorst Martin C. J. Kneyber |
| author_facet | Pauline de Jager Johannes G. M. Burgerhof Alette A. Koopman Dick G. Markhorst Martin C. J. Kneyber |
| author_sort | Pauline de Jager |
| collection | DOAJ |
| description | Abstract Background Titration of the continuous distending pressure during a staircase incremental–decremental pressure lung volume optimization maneuver in children on high-frequency oscillatory ventilation is traditionally driven by oxygenation and hemodynamic responses, although validity of these metrics has not been confirmed. Methods Respiratory inductance plethysmography values were used construct pressure–volume loops during the lung volume optimization maneuver. The maneuver outcome was evaluated by three independent investigators and labeled positive if there was an increase in respiratory inductance plethysmography values at the end of the incremental phase. Metrics for oxygenation (SpO2, FiO2), proximal pressure amplitude, tidal volume and transcutaneous measured pCO2 (ptcCO2) obtained during the incremental phase were compared between outcome maneuvers labeled positive and negative to calculate sensitivity, specificity, and the area under the receiver operating characteristic curve. Ventilation efficacy was assessed during and after the maneuver by measuring arterial pH and PaCO2. Hemodynamic responses during and after the maneuver were quantified by analyzing heart rate, mean arterial blood pressure and arterial lactate. Results 41/54 patients (75.9%) had a positive maneuver albeit that changes in respiratory inductance plethysmography values were very heterogeneous. During the incremental phase of the maneuver, metrics for oxygenation and tidal volume showed good sensitivity (> 80%) but poor sensitivity. The sensitivity of the SpO2/FiO2 ratio increased to 92.7% one hour after the maneuver. The proximal pressure amplitude showed poor sensitivity during the maneuver, whereas tidal volume showed good sensitivity but poor specificity. PaCO2 decreased and pH increased in patients with a positive and negative maneuver outcome. No new barotrauma or hemodynamic instability (increase in age-adjusted heart rate, decrease in age-adjusted mean arterial blood pressure or lactate > 2.0 mmol/L) occurred as a result of the maneuver. Conclusions Absence of improvements in oxygenation during a lung volume optimization maneuver did not indicate that there were no increases in lung volume quantified using respiratory inductance plethysmography. Increases in SpO2/FiO2 one hour after the maneuver may suggest ongoing lung volume recruitment. Ventilation was not impaired and there was no new barotrauma or hemodynamic instability. The heterogeneous responses in lung volume changes underscore the need for monitoring tools during high-frequency oscillatory ventilation. |
| first_indexed | 2024-12-14T07:47:45Z |
| format | Article |
| id | doaj.art-6277c5ca6f31402d9463131ff91a82da |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-14T07:47:45Z |
| publishDate | 2020-11-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-6277c5ca6f31402d9463131ff91a82da2022-12-21T23:10:51ZengSpringerOpenAnnals of Intensive Care2110-58202020-11-011011910.1186/s13613-020-00771-8Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilationPauline de Jager0Johannes G. M. Burgerhof1Alette A. Koopman2Dick G. Markhorst3Martin C. J. Kneyber4Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center GroningenDepartment of Epidemiology, University Medical Center GroningenDepartment of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center GroningenDepartment of Paediatric Intensive Care, Amsterdam UMCDepartment of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center GroningenAbstract Background Titration of the continuous distending pressure during a staircase incremental–decremental pressure lung volume optimization maneuver in children on high-frequency oscillatory ventilation is traditionally driven by oxygenation and hemodynamic responses, although validity of these metrics has not been confirmed. Methods Respiratory inductance plethysmography values were used construct pressure–volume loops during the lung volume optimization maneuver. The maneuver outcome was evaluated by three independent investigators and labeled positive if there was an increase in respiratory inductance plethysmography values at the end of the incremental phase. Metrics for oxygenation (SpO2, FiO2), proximal pressure amplitude, tidal volume and transcutaneous measured pCO2 (ptcCO2) obtained during the incremental phase were compared between outcome maneuvers labeled positive and negative to calculate sensitivity, specificity, and the area under the receiver operating characteristic curve. Ventilation efficacy was assessed during and after the maneuver by measuring arterial pH and PaCO2. Hemodynamic responses during and after the maneuver were quantified by analyzing heart rate, mean arterial blood pressure and arterial lactate. Results 41/54 patients (75.9%) had a positive maneuver albeit that changes in respiratory inductance plethysmography values were very heterogeneous. During the incremental phase of the maneuver, metrics for oxygenation and tidal volume showed good sensitivity (> 80%) but poor sensitivity. The sensitivity of the SpO2/FiO2 ratio increased to 92.7% one hour after the maneuver. The proximal pressure amplitude showed poor sensitivity during the maneuver, whereas tidal volume showed good sensitivity but poor specificity. PaCO2 decreased and pH increased in patients with a positive and negative maneuver outcome. No new barotrauma or hemodynamic instability (increase in age-adjusted heart rate, decrease in age-adjusted mean arterial blood pressure or lactate > 2.0 mmol/L) occurred as a result of the maneuver. Conclusions Absence of improvements in oxygenation during a lung volume optimization maneuver did not indicate that there were no increases in lung volume quantified using respiratory inductance plethysmography. Increases in SpO2/FiO2 one hour after the maneuver may suggest ongoing lung volume recruitment. Ventilation was not impaired and there was no new barotrauma or hemodynamic instability. The heterogeneous responses in lung volume changes underscore the need for monitoring tools during high-frequency oscillatory ventilation.http://link.springer.com/article/10.1186/s13613-020-00771-8HFOVPediatricStaircase lung volume optimization maneuverRespiratory inductance plethysmography |
| spellingShingle | Pauline de Jager Johannes G. M. Burgerhof Alette A. Koopman Dick G. Markhorst Martin C. J. Kneyber Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation Annals of Intensive Care HFOV Pediatric Staircase lung volume optimization maneuver Respiratory inductance plethysmography |
| title | Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation |
| title_full | Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation |
| title_fullStr | Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation |
| title_full_unstemmed | Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation |
| title_short | Physiologic responses to a staircase lung volume optimization maneuver in pediatric high-frequency oscillatory ventilation |
| title_sort | physiologic responses to a staircase lung volume optimization maneuver in pediatric high frequency oscillatory ventilation |
| topic | HFOV Pediatric Staircase lung volume optimization maneuver Respiratory inductance plethysmography |
| url | http://link.springer.com/article/10.1186/s13613-020-00771-8 |
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