Global and Regional Tidal Volume Distribution in Spontaneously Breathing Mechanically Ventilated Children

Jefta van Dijk*, Alette A. Koopman, Robert G.T. Blokpoel, Sandra Dijkstra, Dick G. Markhorst, Johannes G.M. Burgerhof, Martin C.J. Kneyber

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Abstract

BACKGROUND: Allowing the ventilated adult patient to breathe spontaneously may improve tidal volume (VT ) distribution toward the dependent lung regions, reduce shunt fraction, and decrease dead space. It has not been studied if these effects under various levels of ventilatory support also occur in children. We sought to explore the effect of level of ventilatory support on VT distribution and end-expiratory lung volume (EELV) in spontaneously breathing ventilated children in the recovery phase of their acute respiratory failure. METHODS: This is a secondary analysis of data from a prospective clinical trial comparing 2 different ventilator modes during weaning in mechanically ventilated children < 5 y: CPAP + pressure support ventilation (PSV) and pressure control (PC)/intermittent mandatory ventilation (IMV) + PSV with the mandatory breath rate set at 25% of baseline. Using electrical impedance tomography (EIT), we assessed VT distribution by calculating the center of ventilation. Polynomial functions of the second degree were plotted to evaluate regional lung filling characteristics. Changes in end-expiratory impedance were calculated to assess changes in EELV. Baseline measurements were compared with measurements during CPAP/PSV, PC/IMV + PSV, and during a downward titration of the level of pressure support. RESULTS: Thirty-five subjects with a median age 4.5 (2.1–12.9) months and a median ventilation time of 4.9 (3.3–6.9) d were studied. The overall median coefficient of variation was 50.1% and not different between CPAP/PSV or PC/synchronized IMV + PSV. Regional filling characteristics of the lung identified a homogeneous VT distribution under all study conditions. Downtapering of the level of PSV resulted in a significant shift of the coefficient of variation toward the dependent lung regions. CONCLUSIONS: Our data showed that allowing ventilated children in the recovery phase of respiratory failure to breathe spontaneously in a continuous spontaneous ventilation mode did not negatively affect VT distribution or EELV.

Original languageEnglish
Pages (from-to)383-393
Number of pages11
JournalRespiratory care
Volume67
Issue number4
DOIs
Publication statusPublished - 1-Apr-2022

Keywords

  • children
  • electrical impedance tomography
  • intensive care
  • mechanical ventilation
  • pediatric intensive care
  • pediatrics
  • spontaneous breathing
  • weaning

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