Table 2.
Data on lung mechanics, hemodynamics and metrics for oxygenation and gas exchange in N = 22 pediatric patients with acute hypoxemic respiratory failure (a) all patients and (b) mild versus moderate-to-severe PARDS
| All patients (N = 22) | ||
|---|---|---|
| Before | During | |
| (a) | ||
| Lung mechanics | ||
| P plat (cmH2O) | 28 (26–33) | 29 (26–30) |
| mPaw (cmH2O) | 14 (13–16) | 14 (13–15)* |
| Driving pressure (V T/Crs) (cmH2O) | 15.7 (11.6–22.9) | 16.4 (7.9–19.4) |
| Plat–PEEP (cmH2O) | 22 (17–26) | 21 (19–23) |
| PEEP (cmH2O) | 8 (6–10) | 8 (6–10) |
| Respiratory rate (/min)a | 40 (34–43) | 35 (30–40)* |
| Compliance (mL/cmH2O/kg) | 0.51 (0.34–0.77) | 0.45 (0.38–0.87) |
| Resistance (cmH2O/L/kg/s) | 26.2 (5.5–40.6) | 24.5 (6.5–31.3) |
| Hemodynamics | ||
| Heart rate (/min) | 155 (126–170) | 162 (137–176) |
| Mean arterial pressure (mmHg) | 63 (56–73) | 60 (50–69) |
| Metrics for oxygenation and gas exchange | ||
| PaO2 (mmHg) | 65 (58–102) | 76 (66–103) |
| PaCO2 (mmHg) | 48 (44–56) | 51 (44–61) |
| End-tidal CO2 (mmHg) | 39 (35–46) | 39 (35–46) |
| pH | 7.35 (7.30–7.40) | 7.34 (7.22–7.39) |
| Oxygenation index | 12.8 (7.5–16.9) | 10.2 (7.8–14.5)* |
| PaO2/FiO2 ratio | 104 (90–168) | 133 (95–172) |
| SpO2/FiO2 ratio | 150 (115–186) | 142 (111–178) |
| AVDSF | 0.19 (0.10–0.28) | 0.22 (0.14–0.34)** |
| Mild PARDS (N = 6) | Moderate or severe PARDS (N = 16) | |||
|---|---|---|---|---|
| Before | During | Before | During | |
| (b) | ||||
| Lung mechanics | ||||
| P plat (cmH2O) | 28 (23–29) | 29 (24–32) | 30 (26–35) | 29 (26–30) |
| mPaw (cmH2O) | 13 (10–15) | 13 (10–14) | 15 (13–16) | 14 (13–16) |
| Driving pressure (V T/Crs) (cmH2O) | 18.3 (10.6–26.8) | 17.1 (7.1–19.7) | 15.0 (10.0–22.6) | 18.3 (12.5–21.4) |
| Plat–PEEP (cmH2O) | 20 (14–24) | 21 (17–26) | 22 (17–28) | 21 (18–23) |
| PEEP (cmH2O) | 6.5 (5–8.5) | 6.5 (5–8.5) | 8 (7.3–10) | 8 (7.3–10) |
| Respiratory rate (/min)a | 35 (29–50) | 35 (23–46)* | 40 (33–43) | 38 (30–40) |
| Compliance (mL/cmH2O/kg) | 0.66 (0.46–0.98) | 1.16 (0.41–1.81) | 0.50 (0.31–0.70) | 0.45 (0.37–0.82) |
| Resistance (cmH2O/L/kg/s) | 15.8 (3.7–47.6) | 16.0 (2.9–42.0) | 26.2 (8.9–41.3) | 24.5 (10.3–31.3) |
| Hemodynamics | ||||
| Heart rate (/min) | 152 (113–191) | 155 (111–188) | 155 (139–163) | 162 (140–173)* |
| Mean arterial pressure (mmHg) | 71 (60–76) | 63 (53–77) | 60 (55–71) | 58 (49–69) |
| Metrics for oxygenation and gas exchange | ||||
| PaO2 (mmHg) | 128 (99–188) | 102 (74–216) | 62 (56–72) | 70 (63–90)* |
| PaCO2 (mmHg) | 50 (42–59) | 53 (42–65) | 45 (44–58) | 51 (44–61) |
| End-tidal CO2 (mmHg) | 39 (34–49) | 41 (31–49) | 39 (34–46) | 39 (35–44) |
| pH | 7.34 (7.21–7.44) | 7.33 (7.25–7.39) | 7.36 (7.32–7.40) | 7.34 (7.19–7.40) |
| Oxygenation index | 4.5 (4.0–7.2) | 6.1 (4.9–7.5) | 15.2 (12.2–23.3) | 12.5 (10.0–19.1)* |
| PaO2/FiO2 ratio | 286 (164–337) | 207 (151–272) | 100 (81–117) | 109 (87–154)* |
| SpO2/FiO2 ratio | 193 (115–246) | 165 (121–216) | 141 (105–175) | 135 (105–177) |
| AVDSF | 0.20 (0.12–0.31) | 0.24 (0.14–0.32) | 0.17 (0.06–0.26) | 0.22 (0.14–0.35)** |
Data are expressed as median (25–75 interquartile range)
PARDS pediatric acute respiratory distress syndrome, P plat plateau pressure, mPaw mean airway pressure, V T tidal volume measured by the ventilator; respiratory system compliance, AVDSF end-tidal alveolar dead space fraction
* p < 0.05; ** p < 0.01 on paired analysis (before neuromuscular blockade vs during neuromuscular blockade)
aRespiratory rate is the machine breaths and spontaneous breaths