Cardiopulmonary parameters during high PEEP in children

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Abstract
There are few reports of the application of high PEEP (PEEP ≥ 15 cm H2O) in infants and children. Data concerning cardiac index (CI), pulmonary venous admixture (Qsp/Qt), and arterial mixed venous oxygen content difference (avDO2) during mechanical ventilation with high PEEP have not been reported. Fourteen infants and children were treated with high levels of PEEP; 8 of these patients were monitored with pulmonary artery catheters. Cardiopulmonary data were obtained from these 8 patients and pulmonary barotrauma data were tabulated from all 14 patients. At highest PEEP, CI = 3.6 ± 0.6 L/min M2, avDO2 = 4.45 ± 0.83 ml/dl and Qsp/Qt = 16.7 ± 3.1%. One patient experienced severe cardiac depression unresponsive to therapy; it resolved when PEEP was lowered. Pulmonary barotrauma was a frequent complication. Pneumothorax occurred in 6 patients. No patient died from pulmonary barotrauma. We conclude that PEEP ≥ 15 cm H2O can be used in infants and children to decrease Qsp/Qt toward normal; CI and avDO2 can usually be maintained in an acceptable range. Patients should be frequently monitored for pulmonary barotrauma.

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