PMID- 28632754
OWN - NLM
STAT- MEDLINE
DCOM- 20170919
LR  - 20181113
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 6
DP  - 2017
TI  - Permissive hypercapnia for severe acute respiratory distress syndrome in
      immunocompromised children: A single center experience.
PG  - e0179974
LID - 10.1371/journal.pone.0179974 [doi]
AB  - BACKGROUND: Controlled hypoventilation while accepting hypercapnia has been
      advocated to reduce ventilator-induced lung injury. The aim of the study was to
      analyze outcomes of a cohort of immunocompromised children with acute respiratory
      distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2
      targets up to 140 mm Hg. METHODS: Retrospective analysis of outcomes of a cohort 
      of children with oncologic disease or after stem cell transplantation and severe 
      respiratory failure in comparison with a historical control cohort. RESULTS: Out 
      of 150 episodes of admission to the PICU 88 children underwent invasive
      mechanical ventilation for >24h (overall survival 75%). In a subgroup of 38
      children with high ventilator requirements the PCO2 target ranges were increased 
      stepwise. Fifteen children survived and were discharged from the PICU. Severe
      pulmonary hypertension was seen in two patients and no case of cerebral edema was
      observed. Long term outcome was available in 15 patients and 10 of these patients
      survived without adverse neurological sequelae. With introduction of this
      strategy survival of immunocompromised children undergoing mechanical ventilation
      for >24h increased to 48% compared to 32% prior to introduction (historical
      cohort). CONCLUSIONS: A ventilation strategy incorporating very high carbon
      dioxide levels to allow for low tidal volumes and limited inspiratory pressures
      is feasible in children. Even severe hypercapnia may be well tolerated. No severe
      side effects associated with hypercapnia were observed. This strategy could
      potentially increase survival in immunocompromised children with severe ARDS.
FAU - Fuchs, Hans
AU  - Fuchs H
AUID- ORCID: http://orcid.org/0000-0003-1303-3699
AD  - Center for Pediatrics, Department of Neonatology and Pediatric Intensive Care,
      Medical Center - Albert Ludwig University of Freiburg, Faculty of Medicine,
      Freiburg, Germany.
FAU - Rossmann, Nicola
AU  - Rossmann N
AD  - Division of Neonatology and Pediatric Critical Care, Department for Pediatrics
      and Adolescent Medicine, Ulm University, Ulm, Germany.
FAU - Schmid, Manuel B
AU  - Schmid MB
AD  - Department of Neonatology, University Hospital Zurich, University of Zurich,
      Zurich, Switzerland.
FAU - Hoenig, Manfred
AU  - Hoenig M
AD  - Oncology and stem cell transplantation, Department for Pediatrics and Adolescent 
      Medicine, Ulm University, Ulm, Germany.
FAU - Thome, Ulrich
AU  - Thome U
AD  - Division of Neonatology, University Hospital of Leipzig, Leipzig, Germany.
FAU - Mayer, Benjamin
AU  - Mayer B
AD  - Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
FAU - Klotz, Daniel
AU  - Klotz D
AD  - Center for Pediatrics, Department of Neonatology and Pediatric Intensive Care,
      Medical Center - Albert Ludwig University of Freiburg, Faculty of Medicine,
      Freiburg, Germany.
FAU - Hummler, Helmut D
AU  - Hummler HD
AD  - Division of Neonatology and Pediatric Critical Care, Department for Pediatrics
      and Adolescent Medicine, Ulm University, Ulm, Germany.
LA  - eng
PT  - Journal Article
DEP - 20170620
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
SB  - IM
MH  - Blood Gas Analysis
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Hypercapnia/complications/mortality/*pathology
MH  - Hypertension, Pulmonary/complications
MH  - Immunocompromised Host
MH  - Intensive Care Units, Pediatric
MH  - Length of Stay
MH  - Leukemia/therapy
MH  - Male
MH  - *Respiration, Artificial/adverse effects
MH  - Respiratory Distress Syndrome, Adult/complications/*diagnosis
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stem Cell Transplantation
MH  - Survival Rate
PMC - PMC5478142
EDAT- 2017/06/21 06:00
MHDA- 2017/09/20 06:00
CRDT- 2017/06/21 06:00
PHST- 2017/03/26 00:00 [received]
PHST- 2017/06/07 00:00 [accepted]
PHST- 2017/06/21 06:00 [entrez]
PHST- 2017/06/21 06:00 [pubmed]
PHST- 2017/09/20 06:00 [medline]
AID - 10.1371/journal.pone.0179974 [doi]
AID - PONE-D-17-11748 [pii]
PST - epublish
SO  - PLoS One. 2017 Jun 20;12(6):e0179974. doi: 10.1371/journal.pone.0179974.
      eCollection 2017.