Effects of a lung recruitment maneuver keeping PEEP before and after L-Pflex on gas exchange in child ARDS patients

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PEEP titrated by the L-Pflex of static PxV curve of respiratory system associated with recruitment maneuvers improved oxygenation and mortality in ARDS patients. In order to study the effects of PEEP 2 cmH₂0 below and above the L-Pflex without and with a recruitment maneuver on gas exchange and hemodynamic parameters, we analyzed foyr children (7 to 14 months) with ARDS criteriaacute bilateral RX infiltrates, PaO₂/FIO₂ <200, echocardio-graphy without left cardiac dysfunction, (<5 days of installation). All the children were sedated and paralyzed. After a ventilatory control period (TV=10 ml/kg, PEEP=5 cmH₂0), a (0.2 l/min) PxV curve was done for each child and the L-Pflex was calculated. Then the children were ventilated in VCV (6 ml/kg, RR=20/min- Servo-Siemens-300) for 30 min with PEEP 2 cmH₂0 below the L-Pflex withoutcruitment maneuver, then 30 min with the same PEEPlevel associated with a recruitment maneuver (PCV=15 cmH₂0, PEEP between 30 and 40 cmH₂0, according to animmediately previous thoracic CT-scan for each child that showed less than 5% of the lung area between -100 and +100 HU). Then the children were ventilated for 30 more min with PEEP 2 cmH₂0 above the L-Pflex without a recruit-ment maneuver, and finally 30 min with the same PEEP level associated with the recruitment maneuver.

Results

See Table.

Conclusion

A recruitment maneuver according to the findings of the thoracic CT-scan improved oxygenationmainly after PEEP set 2 cmH₂0 above the L-Pflex of thePxV curve, improved CO₂ exchange without hemodynamicimpairment, in child ARDS patients.

Table