A Novel Maneuver to Treat Refractory Atelectasis in Mechanically Ventilated Children.

We developed a novel airway clearance and lung recruitment maneuver for children with refractory unilateral atelectasis undergoing invasive mechanical ventilation. In this retrospective, single-center, proof of concept study, we describe the steps involved in this novel maneuver and evaluate its effectiveness in 15 patients through objective quantitation of changes in respiratory system compliance and in the degree of atelectasis assessed by a validated Modified Radiology Atelectasis Score. Compared with the premaneuver baseline, the median atelectasis score improved significantly following the maneuver (9 [7.5-10] vs. 1 [0-3.3], respectively, p < 0.01). Likewise, dynamic compliance was significantly higher following the maneuver (0.3 [0.32-0.44] vs. 0.61 [0.53-0.69] mL/kg/cm H 2 O, respectively, p < 0.01). No patients required a bronchoscopy. This simple and effective maneuver resulted in a significant improvement in the degree of atelectasis and dynamic compliance in this cohort of mechanically ventilated children with refractory unilateral atelectasis.

Increase in oxygen consumption after albuterol inhalation in ventilated infants and children.

OBJECTIVE: To determine if inhaled albuterol (salbutamol) increases oxygen consumption (V'O2) in children and, if so, the duration of this effect. DESIGN: Oxygen consumption was measured by indirect calorimetry using the Argon dilution technique with a respiratory mass spectrometer. After measurement of baseline values, albuterol was administered and subsequent measurements were performed at 10 minutes, 1 hour, 2 hours, 3 hours, and 4 hours. SETTING: Multidisciplinary PICU in a university teaching hospital. PATIENTS: Eleven intubated infants and children (five girls, six boys) with a mean age of 20 months (range, 1 mo to 8 yr) and a mean weight of 10.7 kg (range, 3.1-23 kg) who required therapeutic albuterol inhalations. INTERVENTION: Nine hundred micrograms of albuterol (10 puffs) was administered by a metered-dose inhaler into a spacer through the inspiratory arm of the ventilator circuit near to the patient, during 10 mechanically assisted breaths. MEASUREMENTS AND MAIN RESULTS: All children showed an increase in V'O2 within 10 minutes (mean increase 48.6%). The increased V'O2 was still elevated (42.3% above baseline) at 1 hour, but 3 hours after albuterol inhalation, the V'O2 was back to baseline in all patients. Heart rate increased significantly at 10 minutes, 1 hour, and 2 hours after inhalation. CONCLUSION: There is a large increase in V'O2 after albuterol inhalation. This effect lasts up to 3 hours.