International Medical Journal, Vol. 26., Iss. 3, 2020, P. 10−13.
CHANGES IN OXYGENATION IN CHILDREN WITH RESPIRATORY FAILURE
Danylo Halytsky National Lviv Medical University, Lviv, Ukraine
Acute respiratory failure is a component of the multiorgan dysfunction syndrome and a common cause of death among the children treated in intensive care units. Readiness to wean a patient from a mechanical ventilation is determined by a set of indices, including the data on the level of hypoxemia and its ability to regress under the influence of oxygen therapy. The indices such as the paO2/FiO2 and SpO2/FiO2 ratios are valid for determining the severity of hypoxemia. In order to study the dynamics of changes in SpO2/FiO2, paO2/FiO2, oxygenation index and the one of frequent shallow breathing in the children with acute respiratory failure as well as to substantiate the criteria for their readiness to wean from pulmonary ventilation, a prospective, observational cohort investigation in patients aged from 1 month to 18 years was performed. The patients of group I received pulmonary−protective strategy of mechanical lung ventilation, II − in addition to it received the diaphragm−protective strategy. The ratios of SpO2/FiO2 and paO2/FiO2, oxygenation index and frequent shallow respiration index were calculated. Weaning was considered successful if the patient did not require a respiratory therapy after extubation for the next 48 hours. The primary endpoint of the assessment was the duration of weaning from mechanical ventilation, the secondary ones were the SpO2 / FiO2, paO2 / FiO2, oxygenation index, the one of frequent shallow breathing. Significant differences in SpO2 / FiO2 and paO2 / FiO2 indices were found on days 5 and 9 of the study. It was found that at paO2 / FiO2 values less than 200 and SpO2 / FiO2 less than 265 the prognosis of weaning is unfavorable.
Key words: children, oxygenation, mechanical ventilation.
1. PaO2/FIO2 Ratio Derived From the SpO2/FIO2 Ratio to Improve Mortality Prediction Using the Pediatric Index of Mortality−3 Score in Transported Intensive Care Admissions / S. Ray et al. // Pediatr. Crit. Care Med. 2017. Vol. 18 (3). e131−e136. doi:10.1097/PCC.0000000000001075
2. Weaning and extubation readiness in pediatric patients / C. J. Newth et al. // Pediatr. Crit. Care Med. 2009. Vol. 10 (1). P. 1−11. doi:10.1097/PCC.0b013e318193724d
3. Correlation of oxygen saturation as measured by pulse oximetry / fraction of inspired oxygen ratio with PaO2 / fraction of inspired oxygen ratio in a heterogeneous sample of critically ill children / C. Lobete et al. // J. Crit Care. 2013. Vol. 28 (4). P. 538.e1−538.e5387. doi:10.1016/j.jcrc.2012.12.006
4. Nonlinear Imputation of PaO2/FIO2 from SpO2/FIO2 among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study / S. M. Brown et al. // Crit. Care Med. 2017. Vol. 45 (8). P. 1317−1324. doi:10.1097/CCM.0000000000002514
5. Nonlinear Imputation of PaO2/FIO2 from SpO2/FIO2 among Patients with Acute Respiratory Distress Syndrome / S. M. Brown et al. // Chest. 2016. Vol. 150 (2). P. 307−313. doi:10.1016/j.chest.2016.01.003
6. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) / M. C. J. Kneyber et al. // Intensive Care Med. 2017. Vol. 43 (12). P. 1764−1780. doi:10.1007/s00134−017−4920−z
7. Beltramo F., Khemani R. G. Definition and global epidemiology of pediatric acute respiratory distress syndrome // Ann. Transl. Med. 2019. Vol. 7 (19). P. 502. doi:10.21037/atm.2019.09.31
8. Schepens T., Dianti J. Diaphragm protection: what should we target? // Curr. Opin. Crit. Care. 2020. Vol. 26 (1). P. 35−40. doi:10.1097/MCC.0000000000000683
9. Schepens T., Fard S., Goligher E. C. Assessing Diaphragmatic Function // Respir. Care. 2020. Vol. 65 (6). P. 807−819. doi:10.4187/respcare.07410
10. Weaning and extubation readiness in pediatric patients / C. J. Newth et al. // Pediatr. Crit. Care Med. 2009. Vol. 10 (1). P. 1−11. doi:10.1097/PCC.0b013e318193724d