Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children

Xie Youjun; Mo Wugui; Wei Yue; Wei Rong; Tang Yupeng; Fu Jun; Lu Gongzhi

doi:doi:10.11648/j.ajp.20180402.15

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Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children

Xie Youjun, Mo Wugui, Wei Yue, Wei Rong, Tang Yupeng, Fu Jun, Lu Gongzhi

Published in American Journal of Pediatrics (Volume 4, Issue 2)

Received: 31 May 2018 Accepted: 21 June 2018 Published: 24 July 2018

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Abstract

To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO₂) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH₂O vs. (9.9±1.6) cmH₂O, P<0.01]. Cdyn and oxygenation index (OI) in the two groups were improved, and the degree of improvement in the treatment group was significantly higher than that in the control group [Cdyn after the experiment at 2 h: (0.39±0.03) mL/(cmH₂O.kg) vs (0.36±0.03) mL/(cmH₂O.kg), P<0.05; 24h: (0.40±0.03) mL/(cmH₂O.kg) vs (0.38±0.03) mL/(cmH₂O.kg), P<0.05; 48 h: (0.43±0.02) mL/(cmH₂O.kg) vs. (0.40±0.02) mL/(cmH₂O.kg), P<0.01; OI after the experiment at 24 h: (20.07±2.12) cmH₂O/mmHg vs (21.94±2.05) cmH₂O/mmHg, P<0.05; 48 h: (17.51±1.64) cmH₂O/mmHg vs (19.82±2.07) cmH₂O/mmHg, P<0.01]. There were no significant differences in heart rate, mean arterial pressure, and cardiac index before and after the experiment (all P>0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, P<0.05; 48 h: (76.67±9.23) ng/L vs (90.10±9.42) ng/L, P<0.01]. The length of mechanical ventilation and hospital stay in the PICU was significantly shorter in the treatment than in the control group [length of mechanical ventilation: (6.62±1.26) days vs (8.06±1.44) days; hospital stay in the PICU: (8.12±1.31) days vs (9.53±1.42) days, all P<0.05). There was no barotrauma and no difference in mortality between the two groups (P>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.

Published in	American Journal of Pediatrics (Volume 4, Issue 2)
DOI	10.11648/j.ajp.20180402.15
Page(s)	41-45
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Children, Positive End-Expiratory Pressure, Respiratory System Dynamic Compliance, Acute Respiratory Distress Syndrome

References

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APA Style

Xie Youjun, Mo Wugui, Wei Yue, Wei Rong, Tang Yupeng, et al. (2018). Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children. American Journal of Pediatrics, 4(2), 41-45. https://doi.org/10.11648/j.ajp.20180402.15

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ACS Style

Xie Youjun; Mo Wugui; Wei Yue; Wei Rong; Tang Yupeng, et al. Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children. Am. J. Pediatr. 2018, 4(2), 41-45. doi: 10.11648/j.ajp.20180402.15

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AMA Style

Xie Youjun, Mo Wugui, Wei Yue, Wei Rong, Tang Yupeng, et al. Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children. Am J Pediatr. 2018;4(2):41-45. doi: 10.11648/j.ajp.20180402.15

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@article{10.11648/j.ajp.20180402.15,
  author = {Xie Youjun and Mo Wugui and Wei Yue and Wei Rong and Tang Yupeng and Fu Jun and Lu Gongzhi},
  title = {Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children},
  journal = {American Journal of Pediatrics},
  volume = {4},
  number = {2},
  pages = {41-45},
  doi = {10.11648/j.ajp.20180402.15},
  url = {https://doi.org/10.11648/j.ajp.20180402.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20180402.15},
  abstract = {To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO2) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH2O vs. (9.9±1.6) cmH2O, P2O.kg) vs (0.36±0.03) mL/(cmH2O.kg), P2O.kg) vs (0.38±0.03) mL/(cmH2O.kg), P2O.kg) vs. (0.40±0.02) mL/(cmH2O.kg), P2O/mmHg vs (21.94±2.05) cmH2O/mmHg, P2O/mmHg vs (19.82±2.07) cmH2O/mmHg, P0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, PP>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.},
 year = {2018}
}

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TY  - JOUR
T1  - Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children
AU  - Xie Youjun
AU  - Mo Wugui
AU  - Wei Yue
AU  - Wei Rong
AU  - Tang Yupeng
AU  - Fu Jun
AU  - Lu Gongzhi
Y1  - 2018/07/24
PY  - 2018
N1  - https://doi.org/10.11648/j.ajp.20180402.15
DO  - 10.11648/j.ajp.20180402.15
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 41
EP  - 45
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20180402.15
AB  - To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO2) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH2O vs. (9.9±1.6) cmH2O, P2O.kg) vs (0.36±0.03) mL/(cmH2O.kg), P2O.kg) vs (0.38±0.03) mL/(cmH2O.kg), P2O.kg) vs. (0.40±0.02) mL/(cmH2O.kg), P2O/mmHg vs (21.94±2.05) cmH2O/mmHg, P2O/mmHg vs (19.82±2.07) cmH2O/mmHg, P0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, PP>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.
VL  - 4
IS  - 2
ER  -

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Author Information

Xie Youjun

Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Mo Wugui

Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Wei Yue

Department of Preventive Medicine, Guangxi Maternity and Child Health Hospital, Nanning, China
Wei Rong

Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Tang Yupeng

Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Fu Jun

Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China
Lu Gongzhi

Department of Pediatric Intensive Care Unit, Guangxi Maternity and Child Health Hospital, Nanning, China

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APA Style

Xie Youjun, Mo Wugui, Wei Yue, Wei Rong, Tang Yupeng, et al. (2018). Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children. American Journal of Pediatrics, 4(2), 41-45. https://doi.org/10.11648/j.ajp.20180402.15

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Xie Youjun; Mo Wugui; Wei Yue; Wei Rong; Tang Yupeng, et al. Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children. Am. J. Pediatr. 2018, 4(2), 41-45. doi: 10.11648/j.ajp.20180402.15

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AMA Style

Xie Youjun, Mo Wugui, Wei Yue, Wei Rong, Tang Yupeng, et al. Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children. Am J Pediatr. 2018;4(2):41-45. doi: 10.11648/j.ajp.20180402.15

Copy | Download

@article{10.11648/j.ajp.20180402.15,
  author = {Xie Youjun and Mo Wugui and Wei Yue and Wei Rong and Tang Yupeng and Fu Jun and Lu Gongzhi},
  title = {Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children},
  journal = {American Journal of Pediatrics},
  volume = {4},
  number = {2},
  pages = {41-45},
  doi = {10.11648/j.ajp.20180402.15},
  url = {https://doi.org/10.11648/j.ajp.20180402.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20180402.15},
  abstract = {To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO2) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH2O vs. (9.9±1.6) cmH2O, P2O.kg) vs (0.36±0.03) mL/(cmH2O.kg), P2O.kg) vs (0.38±0.03) mL/(cmH2O.kg), P2O.kg) vs. (0.40±0.02) mL/(cmH2O.kg), P2O/mmHg vs (21.94±2.05) cmH2O/mmHg, P2O/mmHg vs (19.82±2.07) cmH2O/mmHg, P0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, PP>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - Impact of the Optimal Respiratory System Dynamic Compliance Strategy for Titrating Positive End-Expiratory Pressure on the Prognosis of Acute Respiratory Distress Syndrome in Children
AU  - Xie Youjun
AU  - Mo Wugui
AU  - Wei Yue
AU  - Wei Rong
AU  - Tang Yupeng
AU  - Fu Jun
AU  - Lu Gongzhi
Y1  - 2018/07/24
PY  - 2018
N1  - https://doi.org/10.11648/j.ajp.20180402.15
DO  - 10.11648/j.ajp.20180402.15
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 41
EP  - 45
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20180402.15
AB  - To investigate the impact of the optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP) on the prognosis of acute respiratory distress syndrome (ARDS) in children. A total of 30 patients with ARDS admitted in the pediatric intensive care unit (PICU) of Guangxi Maternity and Child Health Hospital were randomly divided into two groups (n=15). PEEP was set in the control group according to the PEEP/ fraction of inspired oxygen (FiO2) in American ARDS collaboration network while the optimal Cdyn strategy was employed for the treatment group. We used the pressure control ventilation (PCV) mode and small tidal volume (7mL/Kg). Respiratory mechanics, hemodynamics, and inflammatory cytokines were monitored in each group before and after the experiment. The time of mechanical ventilation, hospital stay in the PICU, and 28-day mortality were compared. There were no significant differences in terms of sex, age, and severity of disease between the two groups. The optimal PEEP of the control group was significant lower than that of the treatment group [(6.4±1.4) cmH2O vs. (9.9±1.6) cmH2O, P2O.kg) vs (0.36±0.03) mL/(cmH2O.kg), P2O.kg) vs (0.38±0.03) mL/(cmH2O.kg), P2O.kg) vs. (0.40±0.02) mL/(cmH2O.kg), P2O/mmHg vs (21.94±2.05) cmH2O/mmHg, P2O/mmHg vs (19.82±2.07) cmH2O/mmHg, P0.05). Interleukin-6 (IL-6) in two groups gradually decreased, and the decrease was greater in the treatment group than in the control group [IL-6 after the experiment at 24 h: (84.58±9.11) ng/L vs (93.18±9.27) ng/L, PP>0.05). The optimal Cdyn method for titrating PEEP improved respiratory mechanics in ARDS, shortened the time of mechanical ventilation, and had no serious adverse effect on hemodynamics.
VL  - 4
IS  - 2
ER  -

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