| dc.description | Background: Analysis of respiratory mechanics during mechanical ventilation (MV) is able to estimate resistive, elastic
and inertial components of the working pressure of the respiratory system. Our aim was to discriminate the components
of the working pressure of the respiratory system in infants on MV with severe bronchiolitis admitted to two PICU’s.
Methods: Infants younger than 1 year old with acute respiratory failure caused by severe bronchiolitis underwent
neuromuscular blockade, tracheal intubation and volume controlled MV. Shortly after intubation studies of pulmonary
mechanics were performed using inspiratory and expiratory breath hold. The maximum inspiratory and expiratory flow
(QI and QE) as well as peak inspiratory (PIP), plateau (PPL) and total expiratory pressures (tPEEP) were measured.
Inspiratory and expiratory resistances (RawI and RawE) and Time Constants (KTI and KTE) were calculated.
Results: We included 16 patients, of median age 2.5 (1–5.8) months. Bronchiolitis due to respiratory syncytial virus was
the main etiology (93.8%) and 31.3% had comorbidities. Measured respiratory pressures were PIP 29 (26–31), PPL 24
(20–26), tPEEP 9 [8–11] cmH2O. Elastic component of the working pressure was significantly higher than resistive and
both higher than threshold (tPEEP – PEEP) (P < 0.01). QI was significantly lower than QE [5 (4.27–6.75) v/s 16.5 (12–23.8)
L/min. RawI and RawE were 38.8 (32–53) and 40.5 (22–55) cmH2O/L/s; KTI and KTE [0.18 (0.12–0.30) v/s 0.18 (0.13–0.22)
s], and KTI:KTE ratio was 1:1.04 (1:0.59–1.42).
Conclusions: Analysis of respiratory mechanics of infants with severe bronchiolitis receiving MV shows that the elastic
component of the working pressure of the respiratory system is the most important. The elastic and resistive
components in conjunction with flow profile are characteristic of restrictive diseases. A better understanding of lung
mechanics in this group of patients may lead to change the traditional ventilatory approach to severe bronchiolitis. | |
