Use of electrical impedance tomography to set positive end-expiratory pressure in a pediatric patient with severe acute respiratory distress syndrome

Frade, Marcela Lopes; Vale, Luciana Assis Pires Andrade; Corrêa, Letícia Candançan; Rossi, Felipe de Souza; Terra, Celso de Moraes; Colleti Junior, José

doi:10.31744/einstein_journal/2024CE0952

Dear Editor,

Pediatric acute respiratory distress syndrome is one of the main pediatric intensive care unit admission diagnoses.(¹) The adjustment of positive end-expiratory pressure (PEEP) to improve lung compliance and oxygenation is a key treatment strategy.(²,³) However, there is a lack of evidence regarding the proper adjustment of PEEP during daily care.(⁴,⁵)

To publicize a little-used strategy to set the ideal PEEP, we report a case of a 9-year-old patient admitted to our hospital with Metapneumovirus pneumonia who was mechanically ventilated due to severe acute respiratory distress syndrome. We used electrical impedance tomography in the prone position to set the PEEP for the patient (Figures 1 and 2), aiming to improve oxygenation for better lung compliance and to avoid hemodynamic compromise. Electrical impedance tomography revealed reduced oxygen requirements, which gradually improved. The patient was discharged on day 31 following admission.

Figure 1
Electric impedance tomography to set PEEP

Figure 2
Patient in prone position with the electrical impedance tomography belt

It is important to alert clinicians that although there is a paucity of evidence on the best strategy to adjust PEEP in patients, the use of electrical impedance tomography seems promising.

The work was approved by the Research Ethics Committee of Hospital Israelita Albert Einstein (CAAE: 70860323.2.0000.0071; # 6.235.278).

REFERENCES

¹ Emeriaud G, López-Fernández YM, Iyer NP, Bembea MM, Agulnik A, Barbaro RP, Baudin F, Bhalla A, Brunow de Carvalho W, Carroll CL, Cheifetz IM, Chisti MJ, Cruces P, Curley MA, Dahmer MK, Dalton HJ, Erickson SJ, Essouri S, Fernández A, Flori HR, Grunwell JR, Jouvet P, Killien EY, Kneyber MC, Kudchadkar SR, Korang SK, Lee JH, Macrae DJ, Maddux A, Modesto I Alapont V, Morrow BM, Nadkarni VM, Napolitano N, Newth CJ, Pons-Odena M, Quasney MW, Rajapreyar P, Rambaud J, Randolph AG, Rimensberger P, Rowan CM, Sanchez-Pinto LN, Sapru A, Sauthier M, Shein SL, Smith LS, Steffen K, Takeuchi M, Thomas NJ, Tse SM, Valentine S, Ward S, Watson RS, Yehya N, Zimmerman JJ, Khemani RG; Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) Group on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143-68.
² Costa EL, Borges JB, Melo A, Suarez-Sipmann F, Toufen C Jr, Bohm SH, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. 2009;35(6):1132-7.
³ Rotta AT, Kunrath CL, Wiryawan B. O manejo da síndrome do desconforto respiratório agudo. J Pediatr (Rio J). 2003;79 Suppl 2:S149-60. Review.
⁴ Silvestre C, Vyas H. Paediatric acute respiratory distress syndrome (PARDS). Paediatr Child Health. 2021;31(6):229–32.
⁵ Schneider N, Johnson M. Management of paediatric acute respiratory distress syndrome. BJA Educ. 2022;22(9):364-70. Review.

Associate Editor:
Kenneth Gollob Hospital Israelita Albert Einstein, São Paulo, SP, Brazil ORCID: https://orcid.org/0000-0003-4184-3867

Publication Dates

Publication in this collection
30 Sept 2024
Date of issue
2024

History

Received
19 Dec 2023
Accepted
08 Apr 2024

This content is licensed under a Creative Commons Attribution 4.0 International License.

[1] ¹ Emeriaud G, López-Fernández YM, Iyer NP, Bembea MM, Agulnik A, Barbaro RP, Baudin F, Bhalla A, Brunow de Carvalho W, Carroll CL, Cheifetz IM, Chisti MJ, Cruces P, Curley MA, Dahmer MK, Dalton HJ, Erickson SJ, Essouri S, Fernández A, Flori HR, Grunwell JR, Jouvet P, Killien EY, Kneyber MC, Kudchadkar SR, Korang SK, Lee JH, Macrae DJ, Maddux A, Modesto I Alapont V, Morrow BM, Nadkarni VM, Napolitano N, Newth CJ, Pons-Odena M, Quasney MW, Rajapreyar P, Rambaud J, Randolph AG, Rimensberger P, Rowan CM, Sanchez-Pinto LN, Sapru A, Sauthier M, Shein SL, Smith LS, Steffen K, Takeuchi M, Thomas NJ, Tse SM, Valentine S, Ward S, Watson RS, Yehya N, Zimmerman JJ, Khemani RG; Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) Group on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med. 2023;24(2):143-68.

[2] ² Costa EL, Borges JB, Melo A, Suarez-Sipmann F, Toufen C Jr, Bohm SH, et al. Bedside estimation of recruitable alveolar collapse and hyperdistension by electrical impedance tomography. Intensive Care Med. 2009;35(6):1132-7.

[3] ³ Rotta AT, Kunrath CL, Wiryawan B. O manejo da síndrome do desconforto respiratório agudo. J Pediatr (Rio J). 2003;79 Suppl 2:S149-60. Review.

[4] ⁴ Silvestre C, Vyas H. Paediatric acute respiratory distress syndrome (PARDS). Paediatr Child Health. 2021;31(6):229–32.

[5] ⁵ Schneider N, Johnson M. Management of paediatric acute respiratory distress syndrome. BJA Educ. 2022;22(9):364-70. Review.