Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience.
<h4>Background</h4>Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0179974&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849766128674406400 |
|---|---|
| author | Hans Fuchs Nicola Rossmann Manuel B Schmid Manfred Hoenig Ulrich Thome Benjamin Mayer Daniel Klotz Helmut D Hummler |
| author_facet | Hans Fuchs Nicola Rossmann Manuel B Schmid Manfred Hoenig Ulrich Thome Benjamin Mayer Daniel Klotz Helmut D Hummler |
| author_sort | Hans Fuchs |
| collection | DOAJ |
| description | <h4>Background</h4>Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg.<h4>Methods</h4>Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort.<h4>Results</h4>Out of 150 episodes of admission to the PICU 88 children underwent invasive mechanical ventilation for >24h (overall survival 75%). In a subgroup of 38 children with high ventilator requirements the PCO2 target ranges were increased stepwise. Fifteen children survived and were discharged from the PICU. Severe pulmonary hypertension was seen in two patients and no case of cerebral edema was observed. Long term outcome was available in 15 patients and 10 of these patients survived without adverse neurological sequelae. With introduction of this strategy survival of immunocompromised children undergoing mechanical ventilation for >24h increased to 48% compared to 32% prior to introduction (historical cohort).<h4>Conclusions</h4>A ventilation strategy incorporating very high carbon dioxide levels to allow for low tidal volumes and limited inspiratory pressures is feasible in children. Even severe hypercapnia may be well tolerated. No severe side effects associated with hypercapnia were observed. This strategy could potentially increase survival in immunocompromised children with severe ARDS. |
| format | Article |
| id | doaj-art-aeb40920f61248de9555dc3b062cc6dd |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-aeb40920f61248de9555dc3b062cc6dd2025-08-20T03:04:40ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01126e017997410.1371/journal.pone.0179974Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience.Hans FuchsNicola RossmannManuel B SchmidManfred HoenigUlrich ThomeBenjamin MayerDaniel KlotzHelmut D Hummler<h4>Background</h4>Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg.<h4>Methods</h4>Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort.<h4>Results</h4>Out of 150 episodes of admission to the PICU 88 children underwent invasive mechanical ventilation for >24h (overall survival 75%). In a subgroup of 38 children with high ventilator requirements the PCO2 target ranges were increased stepwise. Fifteen children survived and were discharged from the PICU. Severe pulmonary hypertension was seen in two patients and no case of cerebral edema was observed. Long term outcome was available in 15 patients and 10 of these patients survived without adverse neurological sequelae. With introduction of this strategy survival of immunocompromised children undergoing mechanical ventilation for >24h increased to 48% compared to 32% prior to introduction (historical cohort).<h4>Conclusions</h4>A ventilation strategy incorporating very high carbon dioxide levels to allow for low tidal volumes and limited inspiratory pressures is feasible in children. Even severe hypercapnia may be well tolerated. No severe side effects associated with hypercapnia were observed. This strategy could potentially increase survival in immunocompromised children with severe ARDS.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0179974&type=printable |
| spellingShingle | Hans Fuchs Nicola Rossmann Manuel B Schmid Manfred Hoenig Ulrich Thome Benjamin Mayer Daniel Klotz Helmut D Hummler Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. PLoS ONE |
| title | Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. |
| title_full | Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. |
| title_fullStr | Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. |
| title_full_unstemmed | Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. |
| title_short | Permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children: A single center experience. |
| title_sort | permissive hypercapnia for severe acute respiratory distress syndrome in immunocompromised children a single center experience |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0179974&type=printable |
| work_keys_str_mv | AT hansfuchs permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT nicolarossmann permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT manuelbschmid permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT manfredhoenig permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT ulrichthome permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT benjaminmayer permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT danielklotz permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience AT helmutdhummler permissivehypercapniaforsevereacuterespiratorydistresssyndromeinimmunocompromisedchildrenasinglecenterexperience |