Download PDF
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
,
Michael A. Wien 
2   Division of Pediatric Radiology, Department of Radiology, UH Rainbow Babies & Children's Hospital, Cleveland, Ohio, United States
,
Steven L. Shein 
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
,
Janine E. Zee-Cheng 
4   Division of Hospital Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
,
Alexandre T. Rotta 
5   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

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.

Keywords

atelectasis - mechanical ventilation - pediatric critical care


Publication History

Received: 16 August 2020

Accepted: 03 November 2020

Article published online:
18 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Thomas K, Habibi P, Britto J, Owens CM. Distribution and pathophysiology of acute lobar collapse in the pediatric intensive care unit. Crit Care Med 1999; 27 (08) 1594-1597
    CrossrefPubMedGoogle Scholar
  • 2 Al-Alaiyan S, Dyer D, Khan B. Chest physiotherapy and post-extubation atelectasis in infants. Pediatr Pulmonol 1996; 21 (04) 227-230
    CrossrefPubMedGoogle Scholar
  • 3 Marini JJ. Acute lobar atelectasis. Chest 2019; 155 (05) 1049-1058
    CrossrefPubMedGoogle Scholar
  • 4 Kavanagh BP. Perioperative atelectasis. Minerva Anestesiol 2008; 74 (06) 285-287
    PubMedGoogle Scholar
  • 5 Deakins K, Chatburn RL. A comparison of intrapulmonary percussive ventilation and conventional chest physiotherapy for the treatment of atelectasis in the pediatric patient. Respir Care 2002; 47 (10) 1162-1167
    PubMedGoogle Scholar
  • 6 Prodhan P, Greenberg B, Bhutta AT. et al. Recombinant human deoxyribonuclease improves atelectasis in mechanically ventilated children with cardiac disease. Congenit Heart Dis 2009; 4 (03) 166-173
    CrossrefPubMedGoogle Scholar
  • 7 Erdeve O, Uras N, Atasay B, Arsan S. Efficacy and safety of nebulized recombinant human DNase as rescue treatment for persistent atelectasis in newborns: case-series. Croat Med J 2007; 48 (02) 234-239
    PubMedGoogle Scholar
  • 8 Fedakar A, Aydogdu C, Fedakar A, Ugurlucan M, Bolu S, Iskender M. Safety of recombinant human deoxyribonuclease as a rescue treatment for persistent atelectasis in newborns. Ann Saudi Med 2012; 32 (02) 131-136
    CrossrefPubMedGoogle Scholar
  • 9 Altunhan H, Annagür A, Pekcan S, Ors R, Koç H. Comparing the efficacy of nebulizer recombinant human DNase and hypertonic saline as monotherapy and combined treatment in the treatment of persistent atelectasis in mechanically ventilated newborns. Pediatr Int 2012; 54 (01) 131-136
    CrossrefPubMedGoogle Scholar
  • 10 Hendriks T, de Hoog M, Lequin MH, Devos AS, Merkus PJ. DNase and atelectasis in non-cystic fibrosis pediatric patients. Crit Care 2005; 9 (04) R351-R356
    CrossrefPubMedGoogle Scholar
  • 11 Merkus PJ, de Hoog M, van Gent R, de Jongste JC. DNase treatment for atelectasis in infants with severe respiratory syncytial virus bronchiolitis. Eur Respir J 2001; 18 (04) 734-737
    CrossrefPubMedGoogle Scholar
  • 12 MacKinnon R, Wheeler KI, Sokol J. Endotracheal DNase for atelectasis in ventilated neonates. J Perinatol 2011; 31 (12) 799-801
    CrossrefPubMedGoogle Scholar
  • 13 El Hassan NO, Chess PR, Huysman MW, Merkus PJ, de Jongste JC. Rescue use of DNase in critical lung atelectasis and mucus retention in premature neonates. Pediatrics 2001; 108 (02) 468-470
    CrossrefPubMedGoogle Scholar
  • 14 Durward A, Forte V, Shemie SD. Resolution of mucus plugging and atelectasis after intratracheal rhDNase therapy in a mechanically ventilated child with refractory status asthmaticus. Crit Care Med 2000; 28 (02) 560-562
    CrossrefPubMedGoogle Scholar
  • 15 Ozturk E, Tanidir IC, Haydin S, Onan IS, Odemis E, Bakir I. The use of dornase alpha for post-operative pulmonary atelectasis after congenital heart surgery. Cardiol Young 2014; 24 (05) 807-812
    CrossrefPubMedGoogle Scholar
  • 16 Scolieri P, Adappa ND, Coticchia JM. Value of rigid bronchoscopy in the management of critically ill children with acute lung collapse. Pediatr Emerg Care 2004; 20 (06) 384-386
    CrossrefPubMedGoogle Scholar
  • 17 Holmgren NL, Córdova M, Ortúzar P, Sánchez I. [Role of flexible bronchoscopy in the re-expansion of persistent atelectasis in children]. Arch Bronconeumol 2002; 38 (08) 367-371
    CrossrefPubMedGoogle Scholar
  • 18 Nussbaum E. Pediatric fiberoptic bronchoscopy: clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med 2002; 3 (02) 171-176
    CrossrefPubMedGoogle Scholar
  • 19 Tang LF, Chen ZM. Fiberoptic bronchoscopy in neonatal and pediatric intensive care units: a 5-year experience. Med Princ Pract 2009; 18 (04) 305-309
    CrossrefPubMedGoogle Scholar
  • 20 Kohelet D, Arbel E, Shinwell ES. Flexible fiberoptic bronchoscopy—a bedside technique for neonatologists. J Matern Fetal Neonatal Med 2011; 24 (03) 531-535
    CrossrefPubMedGoogle Scholar
  • 21 Talamoni HL, Pisapia ND, Buendía JA. [Flexible fiberoptic bronchoscopy in children with persistent atelectasis: a case series report]. Arch Argent Pediatr 2015; 113 (02) e106-e108
    PubMedGoogle Scholar
  • 22 Field-Ridley A, Sethi V, Murthi S, Nandalike K, Li ST. Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients: a systematic review. World J Crit Care Med 2015; 4 (01) 77-88
    CrossrefPubMedGoogle Scholar
  • 23 Shein SL, Gallagher JT, Deakins KM, Weinert DM. Prophylactic use of nebulized hypertonic saline in mechanically ventilated children: a randomized blinded pilot study. Respir Care 2016; 61 (05) 586-592
    CrossrefPubMedGoogle Scholar
  • 24 Parke RL, McGuinness SP, Milne D. et al. A new system for assessing atelectasis on chest x-ray after sternotomy for cardiac surgery. Med Imaging Radiol 2014; 2: 2
    CrossrefPubMedGoogle Scholar
  • 25 Galvis AG, Reyes G, Nelson WB. Bedside management of lung collapse in children on mechanical ventilation: saline lavage—simulated cough technique proves simple, effective. Pediatr Pulmonol 1994; 17 (05) 326-330
    CrossrefPubMedGoogle Scholar
  • 26 Gregson RK, Shannon H, Stocks J, Cole TJ, Peters MJ, Main E. The unique contribution of manual chest compression-vibrations to airflow during physiotherapy in sedated, fully ventilated children. Pediatr Crit Care Med 2012; 13 (02) e97-e102
    CrossrefPubMedGoogle Scholar
  • 27 Amaral BLR, de Figueiredo AB, Lorena DM, Oliveira ACO, Carvalho NC, Volpe MS. Effects of ventilation mode and manual chest compression on flow bias during the positive end- and zero end-expiratory pressure manoeuvre in mechanically ventilated patients: a randomised crossover trial. Physiotherapy 2020; 106: 145-153
    CrossrefPubMedGoogle Scholar