Lung Compliance Immediately After Tracheal Intubation in the Pediatric ICU

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 12

Muhammad Hamad, MD (he/him/his)

Children's Hospital of Philadelphia, EGY

Disclosure(s): No relevant financial relationship(s) to disclose.
Akira Nishisaki, MD, MSCE (he/him/his)

Childrens Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.
JS

Justine Shults, PhD, MS

Associate Professor of Biostatistics
The Children's Hospital of Philadelphia

Disclosure information not submitted.
Natalie Napolitano, PhD, MPH, RRT (she/her/hers)

Children's Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.
AN

Amanda Nickel, MSc, RRT, RRT-ACCS, RRT-NPS

Registered Respiratory Therapist Expert
The Children's Hospital of Philadelphia

Disclosure information not submitted.
LH

Lizzie Hyde, N/A

GME Fellow, Anesthesiology And Critical Care Medicine
Children's Hospital of Philadelphia

Disclosure information not submitted.
AT

Alexis Topjian, MD, FCCM, MSCE

Professor
Childrens Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.
Matthew Kirschen, MD, PhD (he/him/his)

Childrens Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.
JH

Jimmy Huh, MD

Professor
Childrens Hospital of Philadelphia

Disclosure information not submitted.
BB

Benjamin B. Bruins, MD

Associate Professor of Anesthesiology, Critical Care and Pediatrics
The Children's Hospital of Philadelphia

Disclosure information not submitted.
AO

Amanda O’Halloran, MD

MD
Children's Hospital of Philadelphia

Disclosure information not submitted.
EM

Elizabeth McGovern, N/A

N/A
Children's Hospital of Philadelphia

Disclosure information not submitted.
VN

Vinay Nadkarni, MD, MS, FCCM

University of Pennsylvania Perelman School of Medicine

Disclosure information not submitted.
Lindsay Shepard, MD (she/her/hers)

Children's Hospital of Philadelphia

Disclosure(s): No relevant financial relationship(s) to disclose.

Introduction: The degree of de-recruitment during BMV and laryngoscopy for tracheal intubation has not been quantified. We aimed to describe the degree of lung de-recruitment after successful tracheal intubation, hypothesizing that lung compliance would increase over time after intubation.

Methods: Retrospective observational study from a convenience sample of prospectively collected pilot data at an academic pediatric ICU. A quantitative respiratory function monitor recorded pressure and volume metrics immediately after tracheal intubation in children. Post-intubation compliance was calculated using expiratory tidal volume (VTe)/driving pressure (dP: peak inspiratory pressure minus positive end expiratory pressure). Compliance was averaged over 3 ventilation breaths at 6 time points (immediately after intubation [C1], after 10, 20, 30, 40, and 50 [C50] breaths). Post-intubation lung de-recruitment was calculated by (C50 – C1)/C50. The association between post-intubation lung de-recruitment and age and respiratory pathology (i.e., respiratory tract disease or anatomy affecting pulmonary resistance or compliance) was evaluated with Wilcoxon rank-sum tests.

Results: Among 79 patients with post-intubation ventilation data, 24% were infants ( < 1 year), 49% were 1-7 years, and 27% were ³8 years; 35% had respiratory disease. The median apneic time for laryngoscopy was 53 [IQR 43, 81] seconds. The median 3-ventilation averaged lung compliance immediately after intubation was 2.1 [1.3, 4.3] mL/cmH2O, and was 3.4 [1.6, 6.0], 4.1 [2.0, 6.6], 3.9 [2.6, 7.1], 4.0 [2.5, 7.0], and 4.9 [3.0, 7.6] mL/cmH2O at 10, 20, 30, 40, and 50 breaths. Median post-intubation de-recruitment was 49% [25%, 74%]. Infant vs non-infant age category (28% [0.5%, 60%] vs 54% [28%, 79%], p=0.02) was associated with lung de-recruitment, whereas respiratory pathology was not (p=0.67).

Conclusions: Substantial lung de-recruitment was common after tracheal intubation in the PICU. Post-intubation lung compliance gradually increases with ventilation after intubation. Further exploration is needed to understand why infants had less lung de-recruitment.