Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome

PurposeTo investigate the difference in the positive end-expiratory pressure (PEEP) selected with chest electrical impedance tomography (EIT) and with global dynamic respiratory system compliance (Crs) in moderate-to-severe pediatric acute respiratory distress syndrome (pARDS).MethodsPatients with m...

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Main Authors: Hong Ren, Li Xie, Zhulin Wang, Xiaoliao Tang, Botao Ning, Teng Teng, Juan Qian, Ying Wang, Lijun Fu, Zhanqi Zhao, Long Xiang
Format: Article
Language:English
Published: Frontiers Media S.A. 2022-05-01
Series:Frontiers in Medicine
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2022.805680/full
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author Hong Ren
Li Xie
Zhulin Wang
Xiaoliao Tang
Botao Ning
Teng Teng
Juan Qian
Ying Wang
Lijun Fu
Zhanqi Zhao
Zhanqi Zhao
Long Xiang
Long Xiang
author_facet Hong Ren
Li Xie
Zhulin Wang
Xiaoliao Tang
Botao Ning
Teng Teng
Juan Qian
Ying Wang
Lijun Fu
Zhanqi Zhao
Zhanqi Zhao
Long Xiang
Long Xiang
author_sort Hong Ren
collection DOAJ
description PurposeTo investigate the difference in the positive end-expiratory pressure (PEEP) selected with chest electrical impedance tomography (EIT) and with global dynamic respiratory system compliance (Crs) in moderate-to-severe pediatric acute respiratory distress syndrome (pARDS).MethodsPatients with moderate-to-severe pARDS (PaO2/FiO2 < 200 mmHg) were retrospectively included. On the day of pARDS diagnosis, two PEEP levels were determined during the decremental PEEP titration for each individual using the best compliance (PEEPC) and EIT-based regional compliance (PEEPEIT) methods. The differences of global and regional compliance (for both gravity-dependent and non-dependent regions) under the two PEEP conditions were compared. In addition, the EIT-based global inhomogeneity index (GI), the center of ventilation (CoV), and standard deviation of regional delayed ventilation (RVDSD) were also calculated and compared.ResultsA total of 12 children with pARDS (5 with severe and 7 with moderate pARDS) were included. PEEPC and PEEPEIT were identical in 6 patients. In others, the differences were only ± 2 cm H2O (one PEEP step). There were no statistical differences in global compliance at PEEPC and PEEPEIT [28.7 (2.84–33.15) vs. 29.74 (2.84–33.47) ml/cm H2O median (IQR), p = 0.028 (the significant level after adjusted for multiple comparison was 0.017)]. Furthermore, no differences were found in regional compliances and other EIT-based parameters measuring spatial and temporal ventilation distributions.ConclusionAlthough EIT provided information on ventilation distribution, PEEP selected with the best Crs might be non-inferior to EIT-guided regional ventilation in moderate-to-severe pARDS. Further study with a large sample size is required to confirm the finding.
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spelling doaj.art-e3c0ad98a40d4d86bef989e4f989a66f2022-12-22T03:25:50ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-05-01910.3389/fmed.2022.805680805680Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress SyndromeHong Ren0Li Xie1Zhulin Wang2Xiaoliao Tang3Botao Ning4Teng Teng5Juan Qian6Ying Wang7Lijun Fu8Zhanqi Zhao9Zhanqi Zhao10Long Xiang11Long Xiang12Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaClinical Research Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Biomedical Engineering, Fourth Military Medical University, Xi’an, ChinaInstitute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, GermanyDepartment of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Neonatal, Second People’s Hospital of Kashgar, Xinjiang, ChinaPurposeTo investigate the difference in the positive end-expiratory pressure (PEEP) selected with chest electrical impedance tomography (EIT) and with global dynamic respiratory system compliance (Crs) in moderate-to-severe pediatric acute respiratory distress syndrome (pARDS).MethodsPatients with moderate-to-severe pARDS (PaO2/FiO2 < 200 mmHg) were retrospectively included. On the day of pARDS diagnosis, two PEEP levels were determined during the decremental PEEP titration for each individual using the best compliance (PEEPC) and EIT-based regional compliance (PEEPEIT) methods. The differences of global and regional compliance (for both gravity-dependent and non-dependent regions) under the two PEEP conditions were compared. In addition, the EIT-based global inhomogeneity index (GI), the center of ventilation (CoV), and standard deviation of regional delayed ventilation (RVDSD) were also calculated and compared.ResultsA total of 12 children with pARDS (5 with severe and 7 with moderate pARDS) were included. PEEPC and PEEPEIT were identical in 6 patients. In others, the differences were only ± 2 cm H2O (one PEEP step). There were no statistical differences in global compliance at PEEPC and PEEPEIT [28.7 (2.84–33.15) vs. 29.74 (2.84–33.47) ml/cm H2O median (IQR), p = 0.028 (the significant level after adjusted for multiple comparison was 0.017)]. Furthermore, no differences were found in regional compliances and other EIT-based parameters measuring spatial and temporal ventilation distributions.ConclusionAlthough EIT provided information on ventilation distribution, PEEP selected with the best Crs might be non-inferior to EIT-guided regional ventilation in moderate-to-severe pARDS. Further study with a large sample size is required to confirm the finding.https://www.frontiersin.org/articles/10.3389/fmed.2022.805680/fullacute respiratory distress syndromelung protective ventilationelectrical impedance tomographypediatricsrespiratory compliance
spellingShingle Hong Ren
Li Xie
Zhulin Wang
Xiaoliao Tang
Botao Ning
Teng Teng
Juan Qian
Ying Wang
Lijun Fu
Zhanqi Zhao
Zhanqi Zhao
Long Xiang
Long Xiang
Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
Frontiers in Medicine
acute respiratory distress syndrome
lung protective ventilation
electrical impedance tomography
pediatrics
respiratory compliance
title Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
title_full Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
title_fullStr Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
title_full_unstemmed Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
title_short Comparison of Global and Regional Compliance-Guided Positive End-Expiratory Pressure Titration on Regional Lung Ventilation in Moderate-to-Severe Pediatric Acute Respiratory Distress Syndrome
title_sort comparison of global and regional compliance guided positive end expiratory pressure titration on regional lung ventilation in moderate to severe pediatric acute respiratory distress syndrome
topic acute respiratory distress syndrome
lung protective ventilation
electrical impedance tomography
pediatrics
respiratory compliance
url https://www.frontiersin.org/articles/10.3389/fmed.2022.805680/full
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