Effect of PEEP on lung aeration in pediatric patients after cardiac surgery: a CT-Based study
Efeito do PEEP na aeração pulmonar em pacientes pediátricos após cirurgia cardíaca: estudo baseado em TC
Solange C. Gimenez, Milene C. Carrilho, Isabela M. Malbouisson, Marcelo Gama de Abreu, Jean-Jacques Rouby, Luiz Marcelo Sá Malbouisson
Abstract
Background
Loss of lung aeration is frequently observed in adult patients following cardiac surgery with cardiopulmonary bypass. Yet, in children, changes in lung aeration following surgical repair of congenital heart defects, and the effects of Positive End-Expiratory Pressure (PEEP), remain uncertain.
Methods
Changes in lung aeration were investigated using volumetric computed tomography in 12 children with congenital acianogenic heart diseases and increased pulmonary flow who underwent total surgical repair under cardiopulmonary bypass. Computed tomography of the lungs was obtained preoperatively during spontaneous breathing and postoperatively during mechanical ventilation with positive end-expiratory pressure of 0, 5 and 10 cm H2O. Gas and tissue lung volume and mass, as well non-aerated, poorly aerated and normally aerated lung compartments were measured.
Results
Median age of patients was 18.3 months, (4 to 24 months), weight was 9.3 § 2.3 kg. Cardiopulmonary bypass duration was 77 § 26 minutes. Preoperatively, pulmonary volume was
545 mL (237‒753 mL), whereby tissue and gas volumes were 48.4% (41.7%‒59.6%), and 51.6% (40.4%‒58.3%), respectively. Non-aerated and normally aerated compartments accounted for 15% and 47.9% of lung tissue, respectively. Postoperatively, at zero PEEP, the non-aerated compartment increased to 27%, while normally-aerated compared decreased to 38.5%. Stepwise PEEP application restored normally aerated lung volume to preoperative levels but did not significantly reduce non-aerated parenchyma.
Conclusion
Loss of lung aeration was pronounced after surgical correction of congenital heart defects. PEEP up to 10 cm H2O restored gas volume but failed to recruit the collapsed parenchyma. Ethical Approval CAPPesq n° 854/01.
Keywords
Resumo
Introdução
A perda de aeração pulmonar é frequentemente observada em pacientes adultos após cirurgia cardíaca com circulação extracorpórea. No entanto, em crianças, as alterações na aeração pulmonar após a correção cirúrgica de defeitos cardíacos congênitos e os efeitos da Pressão Positiva ao Final da Expiração (PEEP) ainda são incertos.
Métodos
As alterações na aeração pulmonar foram investigadas usando tomografia computadorizada volumétrica em 12 crianças com cardiopatias congênitas acianogênicas e fluxo pulmonar aumentado que passaram por correção cirúrgica total sob circulação extracorpórea. A tomografia dos pulmões foi realizada no pré-operatório durante respiração espontânea e no pós-operatório durante ventilação mecânica com PEEP de 0, 5 e 10 cm H2O. Foram medidos o volume e a massa pulmonar de gás e tecido, assim como os compartimentos pulmonares não aerados, pouco aerados e normalmente aerados.
Resultados
A mediana da idade dos pacientes foi 18,3 meses (4 a 24 meses), com peso de 9,3 ± 2,3 kg. A duração da circulação extracorpórea foi de 77 ± 26 minutos. No pré-operatório, o volume pulmonar foi 545 mL (237–753 mL), sendo que os volumes de tecido e gás foram 48,4% (41,7%–59,6%) e 51,6% (40,4%–58,3%), respectivamente. Os compartimentos não aerados e normalmente aerados corresponderam a 15% e 47,9% do tecido pulmonar, respectivamente. No pós-operatório, com PEEP zero, o compartimento não aerado aumentou para 27%, enquanto o normalmente aerado diminuiu para 38,5%. A aplicação gradual de PEEP restaurou o volume pulmonar normalmente aerado aos níveis pré-operatórios, mas não reduziu significativamente o parênquima não aerado.
Conclusion
A perda de aeração pulmonar foi acentuada após a correção cirúrgica de defeitos cardíacos congênitos. PEEP de até 10 cm H2O restaurou o volume de gás, mas não conseguiu recrutar o parênquima colapsado. Aprovação ética CAPPesq nº 854/01.
Palavras-chave
References
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Submitted date:
12/16/2024
Accepted date:
03/16/2025
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