Distribution and pathophysiology of acute lobar collapse in the pediatric intensive care unit

Objective: The high incidence of lower lobe collapse in adult intensive car e patients is well described. We aimed to document the incidence and distri bution of acute lobar collapse in the pediatric intensive care setting. The influence of anatomical and pathophysiological differences between the adu lt and pediatric respiratory tract will be considered. Design: Retrospective review of chest radiograph series. Setting: Tertiary referral center for pediatric intensive care and the Depa rtment of Diagnostic Radiology in a large teaching hospital in England. Patients: Cohort of 160 patients receiving intensive care during a 2-yr per iod (age range, 6 days-18 yrs; median, 23 months). Interventions: None Measurements and Main Results: Twenty-four of 160 children (15%) developed acute lobar collapse during their intensive care unit admission. Isolated r ight upper lobe collapse occurred in 14 patients, right upper lobe in assoc iation with one or more other lobes in five patients, and lobar collapse ot her than the right upper lobe in five patients. The development of lobar co llapse and, in particular, right upper lobe collapse was associated with a lower median age (no collapse, 26 months; lobar collapse, 8 months; right u pper lobe collapse, 4 months). Lobar collapse was significantly associated with the requirement for mechanical ventilation during admission (chi-squar e, 12.18; p = .005). It was observed in association with both high and low endotracheal tube positions. Conclusion: The predominance of upper robe and, in particular, right upper lobe collapse observed in pediatric intensive care patients contrasts with the high incidence of lower lobe collapse in their adult counterparts. Mult iple interrelated factors are likely to be contributory and include the fol lowing: a) anatomical and physiological differences between adults and chil dren; b) the pathophysiology of childhood respiratory disease; c) more crit ical positioning of endotracheal tubes in younger patients and their moveme nt with patient positioning.