Airway closure in infants with acute bronchiolitis on mechanical ventilation

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dc.catalogadorpva
dc.contributor.advisorBruhn, Alejandro
dc.contributor.authorVarela Ortiz, Javier
dc.contributor.otherPontificia Universidad Católica de Chile. Facultad de Medicina
dc.date2025-10-31
dc.date.accessioned2025-01-30T20:37:58Z
dc.date.issued2025
dc.date.updated2025-01-28T04:54:48Z
dc.descriptionTesis (Magíster en Investigación en Ciencias de la Salud)--Pontificia Universidad Católica de Chile, 2025
dc.description.abstractBackground: The pathophysiology of acute bronchiolitis is thought to be explained by the classical mechanism of distal airway obstruction by debris and mucus plugs. However, the alterations in respiratory mechanics described in previous studies suggest that other mechanisms may be involved. Airway closure is a phenomenon mainly characterized by the cyclic collapse of the distal airways, leading to alveolar air trapping, denitrogenation atelectasis, and bronchiolar inflammation. This study aimed to determine whether airway closure is present in patients with severe acute bronchiolitis. Methods: Prospective and observational study in a tertiary-care pediatric intensive care unit at a general hospital in Infants with acute bronchiolitis under mechanical ventilation. We identified the presence of airway closure through a quasistatic pressure-volume curve obtained from a pneumotachometer with a proximal flow sensor. Our findings were corroborated by simultaneously acquiring a pressure-impedance curve and ventilation maps using electrical impedance tomography. Results: Airway closure was confirmed in 7 out of 12 patients with a median airway opening pressure of 14 cmH2O (IQR 11-16). Patients with airway closure exhibited high levels of driving pressure, with a median of 16 cmH2O (IQR 11-17) and low levels of respiratory system compliance, with a median of 0.41 ml/cmH2O/kg (IQR 0.38-0.59). When these parameters were corrected for airway opening pressure, there was a significant decrease in driving pressure, with a median of 9 cmH2O (IQR 9-13), p = 0.027, and a significant increase in respiratory system compliance, with a median of 0.63 ml/cmH2O/kg (IQR 0.51-0.81), p = 0.028. Conclusions: Airway closure is common in ventilated infants with acute bronchiolitis, and its assessment may play a significant role in interpreting respiratory mechanics.
dc.description.version2025-10-31
dc.fechaingreso.objetodigital2025-01-28
dc.format.extent31 páginas
dc.fuente.origenAutoarchivo
dc.identifier.doi10.7764/tesisUC/MED/102124
dc.identifier.urihttps://doi.org/10.7764/tesisUC/MED/102124
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/102124
dc.information.autorucEscuela de Medicina; Bruhn, Alejandro; 0000-0001-8034-1937; 741
dc.information.autorucEscuela de Medicina; Varela Ortiz, Javier; S/I; 1236436
dc.language.isoen
dc.nota.accesocontenido completo
dc.rightsacceso abierto
dc.rights.licenseAtribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleAirway closure in infants with acute bronchiolitis on mechanical ventilation
dc.typetesis de maestría
sipa.codpersvinculados741
sipa.codpersvinculados1236436
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