AUTHOR=Virk Manpreet K. , Hotz Justin C. , Wong Wendy , Khemani Robinder G. , Newth Christopher J. L. , Ross Patrick A. TITLE=Minimal Change in Cardiac Index With Increasing PEEP in Pediatric Acute Respiratory Distress Syndrome JOURNAL=Frontiers in Pediatrics VOLUME=7 YEAR=2019 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2019.00009 DOI=10.3389/fped.2019.00009 ISSN=2296-2360 ABSTRACT=

Objective: To determine if increasing positive end expiratory pressure (PEEP) leads to a change in cardiac index in children with Pediatric Acute Respiratory Distress Syndrome ranging from mild to severe.

Design: Prospective interventional study.

Setting: Multidisciplinary Pediatric Intensive Care Unit in a University teaching hospital.

Patients: Fifteen intubated children (5 females, 10 males) with a median age of 72 months (IQR 11, 132) and a median weight of 19.3 kg (IQR 7.5, 53.6) with a severity of Pediatric Acute Respiratory Distress Syndrome that ranged from mild to severe with a median lung injury score of 2.3 (IQR 2.0, 2.7).

Measurements: Cardiac index (CI) and stroke volume (SV) were measured on baseline ventilator settings and subsequently with a PEEP 4 cmH₂O higher than baseline. Change in CI and SV from baseline values was evaluated using Wilcoxon signed rank test.

Results: A total of 19 paired measurements obtained. The median baseline PEEP was 8 cmH₂O (IQR 8, 10) Range 6–14 cmH₂O. There was no significant change in cardiac index or stroke volume with change in PEEP. Baseline median CI 4.4 L/min/m² (IQR 3.4, 4.8) and PEEP 4 higher median CI of 4.3 L/min/m² (IQR 3.6, 4.8), p = 0.65. Baseline median SV 26 ml (IQR 13, 44) and at PEEP 4 higher median SV 34 ml (IQR 12, 44) p = 0.63.

Conclusion: There is no significant change in cardiac index or stroke volume with increasing PEEP by 4 cmH₂O in a population of children with mild to severe PARDS.

Clinical Trial Registration: The study is registered on Clinical trails.gov under the Identifier: NCT02354365.