The safety and efficacy of sustained inflations as a lung recruitment maneuver in pediatric intensive care unit patients.

OBJECTIVE

To assess the safety and efficacy of sustained inflations (SI) as lung recruitment maneuvers (RMs) in ventilated pediatric intensive care unit (PICU) patients.

DESIGN

Observational, prospective data collection.

SETTING

Tertiary-care PICU.

PATIENTS AND PARTICIPANTS

Thirty-two consecutive ventilated pediatric patients.

INTERVENTIONS

An SI (30-40 cmH(2)O for 15-20 s) was performed following a ventilator disconnection, suctioning, hypoxemia, or routinely every 12 h. Physiologic variables were recorded for 6 h after each SI. All other management was at the attending physician's discretion. The change in variables from pre-SI to post-SI (at 2, 10, and 15 min, 1, 2, 3, 4, 5, and 6 h) was compared using mixed models to account for repeated measures in the same patient.

MEASUREMENTS AND RESULTS

93 RMs were performed on 32 patients (ages 11 days to 14 years). RMs were done after suctioning (58/93, 62%), ventilator disconnect (5/93, 5%), desaturation (8/93, 9%), or routinely (22/93, 24%). Seven of 93 RMs (7.5%) were interrupted for patient agitation, and 2/93 (2.2%) for transient bradycardia. There was no evidence of statistically significant changes in systolic blood pressure, heart rate, or oxygen saturation as measured by pulse oximetry from pre-RM to post-RM, and there were no air leaks. In three patients with altered intracranial compliance, three of eight RM were associated with a spike of intracranial pressure. There was a sustained significant decrease in FiO(2) by 6.1% lasting up to 6 h post-RM.

CONCLUSIONS

RMs (as SI) are safe in ventilated PICU patients and are associated with a significant reduction in oxygen requirements for the 6 h after the RM.