ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY

Detalhes bibliográficos
Autor(a) principal: Galassi,Marcela Salvador
Data de Publicação: 2021
Outros Autores: Arduini,Rodrigo Genaro, Araújo,Orlei Ribeiro de, Sousa,Rosa Masssa Kikuchi, Petrilli,Antonio Sergio, Silva,Dafne Cardoso Bourguignon da
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista Paulista de Pediatria (Ed. Português. Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0103-05822021000100452
Resumo: ABSTRACT Objective: Acute respiratory distress syndrome (ARDS) can be a devastating condition in children with cancer and alveolar recruitment maneuvers (ARMs) can theoretically improve oxygenation and survival. The study aimed to assess the feasibility of ARMs in critically ill children with cancer and ARDS. Methods: We retrospectively analyzed 31 maneuvers in a series of 12 patients (median age of 8.9 years) with solid tumors (n=4), lymphomas (n=2), acute lymphoblastic leukemia (n=2), and acute myeloid leukemia (n=4). Patients received positive end-expiratory pressure from 25 up to 40 cmH20, with a delta pressure of 15 cmH2O for 60 seconds. We assessed blood gases pre- and post-maneuvers, as well as ventilation parameters, vital signs, hemoglobin, clinical signs of pulmonary bleeding, and radiological signs of barotrauma. Pre- and post-values were compared by the Wilcoxon test. Results: Median platelet count was 53,200/mm3. Post-maneuvers, mean arterial pressure decreased more than 20% in two patients, and four needed an increase in vasoactive drugs. Hemoglobin levels remained stable 24 hours after ARMs, and signs of pneumothorax, pneumomediastinum, or subcutaneous emphysema were absent. Fraction of inspired oxygen decreased significantly after ARMs (FiO2; p=0.003). Oxygen partial pressure (PaO2)/FiO2 ratio increased significantly (p=0.0002), and the oxygenation index was reduced (p=0.01), but all these improvements were transient. Recruited patients’ 28-day mortality was 58%. Conclusions: ARMs, although feasible in the context of thrombocytopenia, lead only to transient improvements, and can cause significant hemodynamic instability.
id SPSP-1_7cb9701f12f002868e1ecfadf4610c37
oai_identifier_str oai:scielo:S0103-05822021000100452
network_acronym_str SPSP-1
network_name_str Revista Paulista de Pediatria (Ed. Português. Online)
repository_id_str
spelling ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDYRespiratory insufficiencyNeoplasmsAcute respiratory distress syndromeChildABSTRACT Objective: Acute respiratory distress syndrome (ARDS) can be a devastating condition in children with cancer and alveolar recruitment maneuvers (ARMs) can theoretically improve oxygenation and survival. The study aimed to assess the feasibility of ARMs in critically ill children with cancer and ARDS. Methods: We retrospectively analyzed 31 maneuvers in a series of 12 patients (median age of 8.9 years) with solid tumors (n=4), lymphomas (n=2), acute lymphoblastic leukemia (n=2), and acute myeloid leukemia (n=4). Patients received positive end-expiratory pressure from 25 up to 40 cmH20, with a delta pressure of 15 cmH2O for 60 seconds. We assessed blood gases pre- and post-maneuvers, as well as ventilation parameters, vital signs, hemoglobin, clinical signs of pulmonary bleeding, and radiological signs of barotrauma. Pre- and post-values were compared by the Wilcoxon test. Results: Median platelet count was 53,200/mm3. Post-maneuvers, mean arterial pressure decreased more than 20% in two patients, and four needed an increase in vasoactive drugs. Hemoglobin levels remained stable 24 hours after ARMs, and signs of pneumothorax, pneumomediastinum, or subcutaneous emphysema were absent. Fraction of inspired oxygen decreased significantly after ARMs (FiO2; p=0.003). Oxygen partial pressure (PaO2)/FiO2 ratio increased significantly (p=0.0002), and the oxygenation index was reduced (p=0.01), but all these improvements were transient. Recruited patients’ 28-day mortality was 58%. Conclusions: ARMs, although feasible in the context of thrombocytopenia, lead only to transient improvements, and can cause significant hemodynamic instability.Sociedade de Pediatria de São Paulo2021-01-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0103-05822021000100452Revista Paulista de Pediatria v.39 2021reponame:Revista Paulista de Pediatria (Ed. Português. Online)instname:Sociedade de Pediatria de São Paulo (SPSP)instacron:SPSP10.1590/1984-0462/2021/39/2019275info:eu-repo/semantics/openAccessGalassi,Marcela SalvadorArduini,Rodrigo GenaroAraújo,Orlei Ribeiro deSousa,Rosa Masssa KikuchiPetrilli,Antonio SergioSilva,Dafne Cardoso Bourguignon daeng2021-01-07T00:00:00Zoai:scielo:S0103-05822021000100452Revistahttps://www.rpped.com.br/ONGhttps://old.scielo.br/oai/scielo-oai.phppediatria@spsp.org.br||rpp@spsp.org.br1984-04620103-0582opendoar:2021-01-07T00:00Revista Paulista de Pediatria (Ed. Português. Online) - Sociedade de Pediatria de São Paulo (SPSP)false
dc.title.none.fl_str_mv ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
title ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
spellingShingle ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
Galassi,Marcela Salvador
Respiratory insufficiency
Neoplasms
Acute respiratory distress syndrome
Child
title_short ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
title_full ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
title_fullStr ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
title_full_unstemmed ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
title_sort ALVEOLAR RECRUITMENT MANEUVERS FOR CHILDREN WITH CANCER AND ACUTE RESPIRATORY DISTRESS SYNDROME: A FEASIBILITY STUDY
author Galassi,Marcela Salvador
author_facet Galassi,Marcela Salvador
Arduini,Rodrigo Genaro
Araújo,Orlei Ribeiro de
Sousa,Rosa Masssa Kikuchi
Petrilli,Antonio Sergio
Silva,Dafne Cardoso Bourguignon da
author_role author
author2 Arduini,Rodrigo Genaro
Araújo,Orlei Ribeiro de
Sousa,Rosa Masssa Kikuchi
Petrilli,Antonio Sergio
Silva,Dafne Cardoso Bourguignon da
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Galassi,Marcela Salvador
Arduini,Rodrigo Genaro
Araújo,Orlei Ribeiro de
Sousa,Rosa Masssa Kikuchi
Petrilli,Antonio Sergio
Silva,Dafne Cardoso Bourguignon da
dc.subject.por.fl_str_mv Respiratory insufficiency
Neoplasms
Acute respiratory distress syndrome
Child
topic Respiratory insufficiency
Neoplasms
Acute respiratory distress syndrome
Child
description ABSTRACT Objective: Acute respiratory distress syndrome (ARDS) can be a devastating condition in children with cancer and alveolar recruitment maneuvers (ARMs) can theoretically improve oxygenation and survival. The study aimed to assess the feasibility of ARMs in critically ill children with cancer and ARDS. Methods: We retrospectively analyzed 31 maneuvers in a series of 12 patients (median age of 8.9 years) with solid tumors (n=4), lymphomas (n=2), acute lymphoblastic leukemia (n=2), and acute myeloid leukemia (n=4). Patients received positive end-expiratory pressure from 25 up to 40 cmH20, with a delta pressure of 15 cmH2O for 60 seconds. We assessed blood gases pre- and post-maneuvers, as well as ventilation parameters, vital signs, hemoglobin, clinical signs of pulmonary bleeding, and radiological signs of barotrauma. Pre- and post-values were compared by the Wilcoxon test. Results: Median platelet count was 53,200/mm3. Post-maneuvers, mean arterial pressure decreased more than 20% in two patients, and four needed an increase in vasoactive drugs. Hemoglobin levels remained stable 24 hours after ARMs, and signs of pneumothorax, pneumomediastinum, or subcutaneous emphysema were absent. Fraction of inspired oxygen decreased significantly after ARMs (FiO2; p=0.003). Oxygen partial pressure (PaO2)/FiO2 ratio increased significantly (p=0.0002), and the oxygenation index was reduced (p=0.01), but all these improvements were transient. Recruited patients’ 28-day mortality was 58%. Conclusions: ARMs, although feasible in the context of thrombocytopenia, lead only to transient improvements, and can cause significant hemodynamic instability.
publishDate 2021
dc.date.none.fl_str_mv 2021-01-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0103-05822021000100452
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0103-05822021000100452
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1590/1984-0462/2021/39/2019275
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Sociedade de Pediatria de São Paulo
publisher.none.fl_str_mv Sociedade de Pediatria de São Paulo
dc.source.none.fl_str_mv Revista Paulista de Pediatria v.39 2021
reponame:Revista Paulista de Pediatria (Ed. Português. Online)
instname:Sociedade de Pediatria de São Paulo (SPSP)
instacron:SPSP
instname_str Sociedade de Pediatria de São Paulo (SPSP)
instacron_str SPSP
institution SPSP
reponame_str Revista Paulista de Pediatria (Ed. Português. Online)
collection Revista Paulista de Pediatria (Ed. Português. Online)
repository.name.fl_str_mv Revista Paulista de Pediatria (Ed. Português. Online) - Sociedade de Pediatria de São Paulo (SPSP)
repository.mail.fl_str_mv pediatria@spsp.org.br||rpp@spsp.org.br
_version_ 1750318252085477376