| Title |
Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure
|
|---|---|
| Published in |
Annals of Intensive Care, October 2016
|
| DOI | 10.1186/s13613-016-0206-9 |
| Pubmed ID | |
| Authors |
Marlon E. F. Wilsterman, Pauline de Jager, Robert Blokpoel, Inez Frerichs, Sandra K. Dijkstra, Marcel J. I. J. Albers, Johannes G. M. Burgerhof, Dick G. Markhorst, Martin C. J. Kneyber |
| Abstract |
Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume V T toward non-dependent lung zones. Oxygenation index, PaO2/FiO2 ratio, lung mechanics (plateau pressure, mean airway pressure, respiratory system compliance and resistance), hemodynamics (heart rate, central venous and arterial blood pressures), oxygenation [oxygenation index (OI), PaO2/FiO2 and SpO2/FiO2], ventilation (physiological dead space-to-V T ratio) and electrical impedance tomography measured changes in end-expiratory lung volume (EELV), and V T distribution was measured before and 15 min after the start of continuous infusion of rocuronium 1 mg/kg. Patients were ventilated in a time-cycled, pressure-limited mode with pre-set V T. All ventilator settings were not changed during the study. Twenty-two patients were studied (N = 18 met the criteria for pediatric ARDS). Median age (25-75 interquartile range) was 15 (7.8-77.5) weeks. Pulmonary pathology was present in 77.3%. The median lung injury score was 9 (8-10). The overall median CoV and regional lung filling characteristics were not affected by NMB, indicating no ventilation shift toward the non-dependent lung zones. Regional analysis showed a homogeneous time course of lung inflation during inspiration, indicating no tendency to atelectasis after the introduction of NMB. NMB decreased the mean airway pressure (p = 0.039) and OI (p = 0.039) in all patients. There were no significant changes in lung mechanics, hemodynamics and EELV. Subgroup analysis showed that OI decreased (p = 0.01) and PaO2/FiO2 increased (p = 0.02) in patients with moderate or severe PARDS. NMB resulted in an improved oxygenation index in pediatric patients with AHRF. Distribution of V T and regional lung filling characteristics were not affected. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 59 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 1 | 2% |
| Unknown | 58 | 98% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 9 | 15% |
| Researcher | 7 | 12% |
| Student > Master | 5 | 8% |
| Student > Bachelor | 4 | 7% |
| Student > Doctoral Student | 4 | 7% |
| Other | 13 | 22% |
| Unknown | 17 | 29% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 27 | 46% |
| Nursing and Health Professions | 6 | 10% |
| Engineering | 4 | 7% |
| Biochemistry, Genetics and Molecular Biology | 2 | 3% |
| Arts and Humanities | 1 | 2% |
| Other | 5 | 8% |
| Unknown | 14 | 24% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 October 2016.
All research outputs
#15,390,684
of 22,896,955 outputs
Outputs from Annals of Intensive Care
#829
of 1,049 outputs
Outputs of similar age
#197,196
of 314,045 outputs
Outputs of similar age from Annals of Intensive Care
#15
of 25 outputs
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