Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience.
- Fuchs H Center for Pediatrics, Department of Neonatology and Pediatric Intensive Care, Medical Center - Albert Ludwig University of Freiburg, Faculty of Medicine, Freiburg, Germany.
- Rossmann N Division of Neonatology and Pediatric Critical Care, Department for Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.
- Schmid MB Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Hoenig M Oncology and stem cell transplantation, Department for Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.
- Thome U Division of Neonatology, University Hospital of Leipzig, Leipzig, Germany.
- Mayer B Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
- Klotz D Center for Pediatrics, Department of Neonatology and Pediatric Intensive Care, Medical Center - Albert Ludwig University of Freiburg, Faculty of Medicine, Freiburg, Germany.
- Hummler HD Division of Neonatology and Pediatric Critical Care, Department for Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany.
- 2017-06-21
Published in:
- PloS one. - 2017
Blood Gas Analysis
Child
Child, Preschool
Female
Humans
Hypercapnia
Hypertension, Pulmonary
Immunocompromised Host
Intensive Care Units, Pediatric
Length of Stay
Leukemia
Male
Respiration, Artificial
Respiratory Distress Syndrome, Adult
Retrospective Studies
Severity of Illness Index
Stem Cell Transplantation
Survival Rate
English
BACKGROUND
Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg.
METHODS
Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort.
RESULTS
Out of 150 episodes of admission to the PICU 88 children underwent invasive mechanical ventilation for >24h (overall survival 75%). In a subgroup of 38 children with high ventilator requirements the PCO2 target ranges were increased stepwise. Fifteen children survived and were discharged from the PICU. Severe pulmonary hypertension was seen in two patients and no case of cerebral edema was observed. Long term outcome was available in 15 patients and 10 of these patients survived without adverse neurological sequelae. With introduction of this strategy survival of immunocompromised children undergoing mechanical ventilation for >24h increased to 48% compared to 32% prior to introduction (historical cohort).
CONCLUSIONS
A ventilation strategy incorporating very high carbon dioxide levels to allow for low tidal volumes and limited inspiratory pressures is feasible in children. Even severe hypercapnia may be well tolerated. No severe side effects associated with hypercapnia were observed. This strategy could potentially increase survival in immunocompromised children with severe ARDS.
Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg.
METHODS
Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort.
RESULTS
Out of 150 episodes of admission to the PICU 88 children underwent invasive mechanical ventilation for >24h (overall survival 75%). In a subgroup of 38 children with high ventilator requirements the PCO2 target ranges were increased stepwise. Fifteen children survived and were discharged from the PICU. Severe pulmonary hypertension was seen in two patients and no case of cerebral edema was observed. Long term outcome was available in 15 patients and 10 of these patients survived without adverse neurological sequelae. With introduction of this strategy survival of immunocompromised children undergoing mechanical ventilation for >24h increased to 48% compared to 32% prior to introduction (historical cohort).
CONCLUSIONS
A ventilation strategy incorporating very high carbon dioxide levels to allow for low tidal volumes and limited inspiratory pressures is feasible in children. Even severe hypercapnia may be well tolerated. No severe side effects associated with hypercapnia were observed. This strategy could potentially increase survival in immunocompromised children with severe ARDS.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1371/journal.pone.0179974
- PMID 28632754
- Persistent URL
- https://sonar.ch/global/documents/94526
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