دورية أكاديمية
Effect of manual hyperinflation with versus without positive end-expiratory pressure on dynamic compliance in pediatric patients following congenital heart surgery: A randomized controlled trial.
| العنوان: | Effect of manual hyperinflation with versus without positive end-expiratory pressure on dynamic compliance in pediatric patients following congenital heart surgery: A randomized controlled trial. |
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| المؤلفون: | Guimarães JC; Department of Pediatrics, Division of Pediatric Critical Care, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., da Silva TH; Department of Pediatrics, Division of Pediatric Critical Care, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Aragon DC; Department of Pediatrics, Division of Pediatric Critical Care, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Johnston C; Department of Pediatrics, Division of Pediatric Critical Care, São Paulo Medical School, University of São Paulo, São Paulo, Brazil., Gastaldi AC; Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Carlotti AP; Department of Pediatrics, Division of Pediatric Critical Care, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil. |
| المصدر: | Medicine [Medicine (Baltimore)] 2023 Oct 27; Vol. 102 (43), pp. e35715. |
| نوع المنشور: | Randomized Controlled Trial; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins |
| مواضيع طبية MeSH: | Cardiac Surgical Procedures* , Heart Defects, Congenital*/surgery, Humans ; Child ; Respiration, Artificial/methods ; Positive-Pressure Respiration/methods ; Lung |
| مستخلص: | Background: We aimed to compare the effect of manual hyperinflation with versus without positive end-expiratory pressure (PEEP) on dynamic compliance of the respiratory system in pediatric patients undergoing congenital heart surgery; to assess the safety of the technique in this population. Methods: This was a randomized controlled trial conducted at the pediatric intensive care unit (PICU) of a tertiary-care hospital. Patients admitted to the PICU following cardiac surgery and receiving postoperative mechanical ventilation were randomized to the experimental or control group. Patients in the experimental group (n = 14) underwent manual hyperinflation with a PEEP valve set at 5 cm H2O, once daily, during the first 48 hours after surgery. Patients allocated to the control group (n = 16) underwent manual hyperinflation without PEEP, at the same time points. Lung mechanics was assessed before (T0) and 5 minutes (T5) after manual hyperinflation. The primary endpoint was dynamic compliance. Secondary outcomes included oxygen saturation index, duration of mechanical ventilation, length of stay, 28-day mortality and safety. Results: Demographic and clinical characteristics were comparable in both groups. There was no significant difference in dynamic compliance between times in each group (Day 1: (mean) 0.78 vs 0.81 and 0.70 vs 0.77; Day 2: 0.85 vs 0.78 and 0.67 vs 0.68 mL/kg/cm H2O, in experimental and control groups, respectively; P > .05). Mean deltas of dynamic compliance were not significantly different between groups. The proportion of patients extubated <72 hours after surgery was similar in experimental and control groups (43% vs 50%, respectively; P = .73). Oxygen saturation index, length of stay, and 28-day mortality were not significantly different between groups. None of the patients had hemodynamic instability. Conclusions: Manual hyperinflation was safe and well tolerated in pediatric patients following surgery for congenital heart disease. No significant change in dynamic compliance of the respiratory system or in oxygenation was observed with the use of manual hyperinflation with or without PEEP in this population. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.) |
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| تواريخ الأحداث: | Date Created: 20231031 Date Completed: 20231102 Latest Revision: 20240208 |
| رمز التحديث: | 20240208 |
| مُعرف محوري في PubMed: | PMC10615438 |
| DOI: | 10.1097/MD.0000000000035715 |
| PMID: | 37904390 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1536-5964 |
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| DOI: | 10.1097/MD.0000000000035715 |