Influence of different positive end-expiratory pressure on prognosis in infants with septic shock and acute respiratory distress syndrome / 中国小儿急救医学

ABSTRACT

Objective To evaluate the influence of different positive end-expiratory pressure (PEEP) on prognosis in infants with septic shock and acute respiratory distress syndrome(ARDS).Methods Sixty infants who were diagnosed with septic shock and ARDS in PICU of Guangxi Maternity and Child Health Hospital were enrolled,which were randomly divided into low PEEP(3 cmH2O,1 cmH2O =0.098 kPa) group,medium PEEP (6 cmH2 O) group and high PEEP (9 cmH2O) group,with 20 cases in each group.All patients received pressure control ventilation mode and small tidal volume (6 ～ 8 ml/kg) strategy,meanwhile implemented liquid recovery according to the septic shock guidelines (2009)enacted by the American Association of Pediatric Advanced Life Support (PALS).The changes of O1,Cdyn and CI before and 6 h,24 h and 48 h after the experiment were monitored,fluid intake/output of all infants were counted.The lengths of mechanical ventilation,hospital stays in PICU and 28-day mortality were compared.Results 6 h,24 h and 48 h after mechanical ventilation,the changes of OI,Cdyn in medium PEEP group and high PEEP group were better than those of low PEEP group respectively (P ＜ 0.01,respectively).The values of CI in low PEEP group and medium PEEP group were higher than that of high PEEP group respectively(P ＜0.01,respectively).There were no significant differences in urine output among three groups (P ＞ 0.05).The lengths of mechanical ventilation and hospital stays in PICU in medium PEEP group [(5.40 ± 0.61) d,(7.00±0.61) d]were shorter than those of the high PEEP and low PEEP groups [(6.23 ±0.90)d,(7.51 ± 1.09) d; (8.23 ± 0.90) d,(9.14 ± 1.21) d] (P ＜ 0.01,respectively).There were no significant differences in mortality among three groups (P ＞ 0.05).Conclusion Medium PEEP can significantly improve lung function of infants who are diagnosed with septic shock and ARDS,shorten the lengths of mechanical ventilation,and has no serious adverse effect on hemodynamics.