Titration of positive end-expiratory pressure with electrical impedance tomography in pediatrics

Abstract

Background: Electrical impedance tomography (EIT) is widely used in the practice of patients with respiratory distress syndrome (ARDS), but little is known about the determination of adequate positive end-expiratory pressure (PEEP) in the pediatric intensive care unit. Aim: Evaluating the effects of titration of PEEP with EIT after alveolar recruitment in children with ARDS on ventilatory variables and blood gas analysis. Methods: This is a longitudinal analytical study carried out in the pediatric intensive care unit. The study included 5 patients diagnosed with ARDS, aged between 6 and 11 years and had an indication for alveolar recruitment maneuver (RM). The EIT belt was posicionated around the sternum and the ventilatory variables were collected (compliance, regional ventilation, driving pressure, alveolar overdistension, alveolar collapse and PEEP titration) and blood gas analysis. The RM was performed in steps, then PEEP titration was performed with the help of the EIT. Results: There was a significant improvement in the ventilatory variables and blood gas analysis of the participants after PEEP titration. The parameters that most changed the pre-and posttitration values were pulmonary compliance (p<0.05), alveolar overdistension (p<0.05), partial pressure of carbon dioxide (p<0.01), blood pressure of oxygen and arterial oxygen saturation (p<0.05). Conclusion: Titration of PEEP with the aid of EIT is safety, improving ventilation and basic acid balance in children with ARDS.