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Recent advances in intubation and mechanical ventilation
1North Staffordshire Hospital NHS Trust, Newcastle Road, Stoke on Trent, Staffordshire ST4 6QG, UK. armagnay@attavista.com
Insights
This review covers advances in respiratory care for critically ill children, focusing on mechanical ventilation strategies and non-invasive support. It highlights evidence-based practices for acute lung injury management in pediatric intensive care.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Therapy
- Neonatology
Background:
- Effective respiratory support is crucial for critically ill infants and children.
- Seamless care involves early recognition, intervention, and advanced life support.
- Advances in respiratory care aim to optimize outcomes for critically ill pediatric patients.
Purpose of the Study:
- To discuss recent advances in respiratory care for critically ill children.
- To review decisions regarding respiratory support, including intubation and mechanical ventilation.
- To explore evidence-based management of acute lung injury in pediatric intensive care.
Main Methods:
- Review of current literature and recent randomized controlled trials.
- Discussion of non-invasive respiratory support modalities.
- Analysis of advanced mechanical ventilation strategies and adjunct therapies.
Main Results:
- Non-invasive support (CPAP, BiPAP, NETP) offers alternatives to intubation.
- Mechanical ventilation choices are guided by airway protection, toilet, and support needs.
- Evidence supports specific PEEP levels, recruitment maneuvers, HFV, and iNO for ALI.
Conclusions:
- Optimizing respiratory support is key in pediatric critical care.
- Evidence-based strategies improve outcomes in acute lung injury.
- Continuous advancements in respiratory care enhance the management of critically ill children.
Abstract:
The ideal care of the critically ill infant or child should demonstrate a seamless service starting with recognition of potential critical illness and initiation of early resuscitative interventions, escalating to advanced life support and skilled transfer to an appropriate location where intensive care can be continued. This article discusses advances in the package of respiratory care commencing with the decision to provide respiratory support, which includes the decision whether or not to intubate, leading to the choice of mechanical ventilatory support mode in the critically ill child. Indications for intubation include protection of the airway, airway toilet and the need for positive pressure support. Respiratory support may not always require additional airway protection or airway toilet. Non-invasive respiratory support includes continuous positive airway pressure, biphasic positive airway pressure, or negative extrathoracic pressure. Recent advances in understanding and management of acute lung injury, such as appropriate use of positive end-expiratory airway pressure, alveolar recruitment manoeuvres, high frequency ventilation and use of inhaled nitric oxide, will be discussed in the light of recent randomised controlled trials providing evidence of benefit.