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Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support

BACKGROUND: Acute viral bronchiolitis (AVB) is a very frequent disease that affects the lower airways of young children increasing the inspiratory and expiratory resistance in variable degree as well as reducing the pulmonary compliance. It would be desirable to know whether these variables are asso...

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Autores principales: Andreolio, Cinara, Piva, Jefferson P, Bruno, Francisco, da Rocha, Tais S, Garcia, Pedro CR
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Jaypee Brothers Medical Publishers 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874293/
https://www.ncbi.nlm.nih.gov/pubmed/33603308
http://dx.doi.org/10.5005/jp-journals-10071-23594
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author Andreolio, Cinara
Piva, Jefferson P
Bruno, Francisco
da Rocha, Tais S
Garcia, Pedro CR
author_facet Andreolio, Cinara
Piva, Jefferson P
Bruno, Francisco
da Rocha, Tais S
Garcia, Pedro CR
author_sort Andreolio, Cinara
collection PubMed
description BACKGROUND: Acute viral bronchiolitis (AVB) is a very frequent disease that affects the lower airways of young children increasing the inspiratory and expiratory resistance in variable degree as well as reducing the pulmonary compliance. It would be desirable to know whether these variables are associated with the outcome. OBJECTIVES: To evaluate the respiratory mechanics in infants with AVB requiring mechanical ventilation (MV) support and to evaluate if respiratory mechanics predict outcomes in children with AVB supported on MV. To evaluate the respiratory mechanics in infants with AVB submitted to MV. MATERIALS AND METHODS: A prospective observational study was conducted in two pediatric intensive care units (PICUs) between February 2016 and March 2017. Included were infants (1 month to 1 year old) admitted with AVB and requiring MV for >48 hours. Auto-PEEP, dynamic compliance (Cdyn), static compliance (Cstat), expiratory resistance (ExRes), and inspiratory resistance (InRes) were evaluated once daily on the second and third day of MV. RESULTS: A total of 64 infants (median age of 2.8 months and a mean weight of 4.8 ± 1.7 kg) were evaluated. A mean positive inspiratory pressure (PIP) of 31.5 ± 5.2 cmH(2)O, positive end-expiratory pressure (PEEP) of 5.5 ± 1.4 cmH(2)O, resulting in a mean airway pressure (MAP) of 12.5 ± 2.2 cmH(2)O and delta pressure of 22.5 ± 4.4 cmH(2)O without difference between the two hospitals. Measurements of respiratory mechanics showed high values of InRes and ExRes (median 142 [IQ(25–75) 106–180] cmH(2)O/L/s and 158 [IQ(25–75) 130–195.3] cmH(2)O/L/s, respectively), accompanied by decreased Cdyn and Cstat (0.46 ± 0.19 and 0.81 ± 0.25 mL/kg/cmH(2)O, respectively). None of the variables was associated with mortality, length of MV, or length of PICU stay. CONCLUSION: Infants with AVB requiring MV support present very high InRes and ExRes values. These findings might be the reason for the aggressive ventilatory parameters, especially PIP, required to ventilate this group of children with lower airway obstruction. CLINICAL SIGNIFICANCE: Monitoring respiratory mechanics could represent a useful tool to guide the ventilatory strategy to be adopted in patients with AVB. HOW TO CITE THIS ARTICLE: Andreolio C, Piva JP, Bruno F, da Rocha TS, Garcia PCR. Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support. Indian J Crit Care Med 2021;25(1):88–93.
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spelling pubmed-78742932021-02-17 Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support Andreolio, Cinara Piva, Jefferson P Bruno, Francisco da Rocha, Tais S Garcia, Pedro CR Indian J Crit Care Med Pediatric Critical Care BACKGROUND: Acute viral bronchiolitis (AVB) is a very frequent disease that affects the lower airways of young children increasing the inspiratory and expiratory resistance in variable degree as well as reducing the pulmonary compliance. It would be desirable to know whether these variables are associated with the outcome. OBJECTIVES: To evaluate the respiratory mechanics in infants with AVB requiring mechanical ventilation (MV) support and to evaluate if respiratory mechanics predict outcomes in children with AVB supported on MV. To evaluate the respiratory mechanics in infants with AVB submitted to MV. MATERIALS AND METHODS: A prospective observational study was conducted in two pediatric intensive care units (PICUs) between February 2016 and March 2017. Included were infants (1 month to 1 year old) admitted with AVB and requiring MV for >48 hours. Auto-PEEP, dynamic compliance (Cdyn), static compliance (Cstat), expiratory resistance (ExRes), and inspiratory resistance (InRes) were evaluated once daily on the second and third day of MV. RESULTS: A total of 64 infants (median age of 2.8 months and a mean weight of 4.8 ± 1.7 kg) were evaluated. A mean positive inspiratory pressure (PIP) of 31.5 ± 5.2 cmH(2)O, positive end-expiratory pressure (PEEP) of 5.5 ± 1.4 cmH(2)O, resulting in a mean airway pressure (MAP) of 12.5 ± 2.2 cmH(2)O and delta pressure of 22.5 ± 4.4 cmH(2)O without difference between the two hospitals. Measurements of respiratory mechanics showed high values of InRes and ExRes (median 142 [IQ(25–75) 106–180] cmH(2)O/L/s and 158 [IQ(25–75) 130–195.3] cmH(2)O/L/s, respectively), accompanied by decreased Cdyn and Cstat (0.46 ± 0.19 and 0.81 ± 0.25 mL/kg/cmH(2)O, respectively). None of the variables was associated with mortality, length of MV, or length of PICU stay. CONCLUSION: Infants with AVB requiring MV support present very high InRes and ExRes values. These findings might be the reason for the aggressive ventilatory parameters, especially PIP, required to ventilate this group of children with lower airway obstruction. CLINICAL SIGNIFICANCE: Monitoring respiratory mechanics could represent a useful tool to guide the ventilatory strategy to be adopted in patients with AVB. HOW TO CITE THIS ARTICLE: Andreolio C, Piva JP, Bruno F, da Rocha TS, Garcia PCR. Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support. Indian J Crit Care Med 2021;25(1):88–93. Jaypee Brothers Medical Publishers 2021-01 /pmc/articles/PMC7874293/ /pubmed/33603308 http://dx.doi.org/10.5005/jp-journals-10071-23594 Text en Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd. © Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Pediatric Critical Care
Andreolio, Cinara
Piva, Jefferson P
Bruno, Francisco
da Rocha, Tais S
Garcia, Pedro CR
Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support
title Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support
title_full Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support
title_fullStr Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support
title_full_unstemmed Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support
title_short Airway Resistance and Respiratory Compliance in Children with Acute Viral Bronchiolitis Requiring Mechanical Ventilation Support
title_sort airway resistance and respiratory compliance in children with acute viral bronchiolitis requiring mechanical ventilation support
topic Pediatric Critical Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874293/
https://www.ncbi.nlm.nih.gov/pubmed/33603308
http://dx.doi.org/10.5005/jp-journals-10071-23594
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