J Pediatr Intensive Care 2022; 11(02): 159-167
DOI: 10.1055/s-0040-1721508
Original Article

A Novel Maneuver to Treat Refractory Atelectasis in Mechanically Ventilated Children

Alejandro J. Martinez Herrada
1   Division of Pediatric Critical Care Medicine, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, United States
2   Division of Pediatric Radiology, Department of Radiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, United States
1   Division of Pediatric Critical Care Medicine, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, United States
John K. Maher
3   Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
4   Division of Hospital Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
5   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
› Author Affiliations
Funding None.


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 H2O, 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.

Publication History

Received: 16 August 2020

Accepted: 03 November 2020

Article published online:
18 December 2020

© 2020. Thieme. All rights reserved.

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