Respiratory mechanics and lung stress/strain in children with acute respiratory distress syndrome

Davide Chiumello, Giovanna Chidini, Edoardo Calderini, Andrea Colombo, Francesco Crimella, Matteo Brioni, Davide Chiumello, Giovanna Chidini, Edoardo Calderini, Andrea Colombo, Francesco Crimella, Matteo Brioni

Abstract

Background: In sedated and paralyzed children with acute respiratory failure, the compliance of respiratory system and functional residual capacity were significantly reduced compared with healthy subjects. However, no major studies in children with ARDS have investigated the role of different levels of PEEP and tidal volume on the partitioned respiratory mechanic (lung and chest wall), stress (transpulmonary pressure) and strain (inflated volume above the functional residual capacity).

Methods: The end-expiratory lung volume was measured using a simplified closed circuit helium dilution method. During an inspiratory and expiratory pause, the airway and esophageal pressure were measured. Transpulmonary pressure was computed as the difference between airway and esophageal pressure.

Results: Ten intubated sedated paralyzed healthy children and ten children with ARDS underwent a PEEP trial (4 and 12 cmH2O) with a tidal volume of 8, 10 and 12 ml/kgIBW. The two groups were comparable for age and BMI (2.5 [1.0-5.5] vs 3.0 [1.7-7.2] years and 15.1 ± 2.4 vs 15.3 ± 3.0 kg/m(2)). The functional residual capacity in ARDS patients was significantly lower as compared to the control group (10.4 [9.1-14.3] vs 16.6 [11.7-24.6] ml/kg, p = 0.04). The ARDS patients had a significantly lower respiratory system and lung compliance as compared to control subjects (9.9 ± 5.0 vs 17.8 ± 6.5, 9.3 ± 4.9 vs 16.9 ± 4.1 at 4 cmH2O of PEEP and 11.7 ± 5.8 vs 23.7 ± 6.8, 10.0 ± 4.9 vs 23.4 ± 7.5 at 12 cmH2O of PEEP). The compliance of the chest wall was similar in both groups (76.7 ± 30.2 vs 94.4 ± 76.4 and 92.6 ± 65.3 vs 90.0 ± 61.7 at 4 and 12 cmH2O of PEEP). The lung stress and strain were significantly higher in ARDS patients as compared to control subjects and were poorly related to airway pressure and tidal volume normalized for body weight.

Conclusions: Airway pressures and tidal volume normalized to body weight are poor surrogates for lung stress and strain in mild pediatric ARDS.

Trial registration: Clinialtrials.gov NCT02036801. Registered 13 January 2014.

Keywords: Acute respiratory distress syndrome; Functional residual capacity; Lung strain; Lung stress; PEEP; Tidal volume; Ventilator-induced lung injury.

Figures

Fig. 1
Fig. 1
Pressure volume curve of respiratory system, lung and chest wall in control (left panel) and ARDS patients (right panel)
Fig. 2
Fig. 2
Lung stress (left panel) and strain (right panel) at 8 and 12 ml/kg of ideal body weight in control and ARDS patients. Individual values are reported for ARDS (solid circle) and control group (open circle), and black solid lines represent mean values of each group
Fig. 3
Fig. 3
Relationship between the changes in transpulmonary plateau pressure and airway plateau pressure in control (left panel) and ARDS patients (right panel). In both groups, the solid lines represent the relationship observed in each individual subject in the six experimental conditions (three different tidal volumes 8, 10 and 12 ml/kg of ideal body weight at two different levels of PEEP 4 and 8 cmH2O)

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