Objective: Optimizing alveolar recruitment by alveolar recruitment strategy (ARS) and maintaining lung volume with adequate positive end-expiratory pressure (PEEP) allow preventing ventilator-induced lung injury (VILI). Knowing that PEEP has its most beneficial effects when dynamic compliance of respiratory system (Crs) is maximized, we hypothesize that the use of 8 cm H2O PEEP with ARS results in an increase in Crs and end-expiratory lung volume (EELV) compared to 8 cm H2O PEEP without ARS and to zero PEEP in pediatric patients undergoing cardiac surgery for congenital heart disease. Methods: Twenty consecutive children were studied. Three different ventilation strategies were applied to each patient in the following order: 0 cm H2O PEEP, 8 cm H2O PEEP without an ARS, and 8 cm H2O PEEP with a standardized ARS. At the end of each ventilation strategy, Crs, EELV, and arterial blood gases were measured. Results: EELV, Crs, and PaO2/FiO2ratio changed significantly (P < 0.001) with the application of 8 cm H2O + ARS. Mean PaCO2- PETCO2difference between 0 PEEP and 8 cm H2O PEEP + ARS was also significant (P < 0.05). Conclusion: An alveolar recruitment strategy with relative high PEEP significantly improves Crs, oxygenation, PaCO2- PETCO2difference, and EELV in pediatric patients undergoing cardiac surgery for congenital heart disease.

Additional Metadata
Keywords Alveolar recruitment, Dynamic compliance, Pediatric, Positive end-expiratory pressure
Persistent URL dx.doi.org/10.1111/j.1460-9592.2009.03177.x, hdl.handle.net/1765/24806
Citation
Scohy, T.V., Bikker, I.G., Hofland, J., de Jong, P.L., Bogers, A.J.J.C., & Gommers, D.A.M.P.J.. (2009). Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end-expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease. Paediatric Anaesthesia, 19(12), 1207–1212. doi:10.1111/j.1460-9592.2009.03177.x