[Ventilation in special situations. Mechanical ventilation in bronchiolitis]

Area of Science:

• Pediatric Respiratory Medicine
• Critical Care Medicine

Context:

• Bronchiolitis is a common infant respiratory illness often necessitating hospitalization and mechanical ventilation.
• Infants may develop respiratory failure or apnea, requiring advanced respiratory support.
• The disease presents a spectrum from obstructive to restrictive patterns, influencing ventilation strategies.

Purpose:

• To outline evidence-based mechanical ventilation strategies for infants with bronchiolitis.
• To differentiate ventilation approaches based on obstructive versus restrictive disease patterns.
• To guide the selection of ventilation modalities and settings to optimize patient outcomes.

Summary:

• Non-invasive ventilation is recommended for obstructive and hypoxemic restrictive patterns, preferably using pressure-controlled modes.
• Monitoring for air trapping in obstructive cases and using positive end-expiratory pressure (PEEP) in restrictive cases are crucial.
• High-frequency oscillatory ventilation is reserved for severe hypoxemia or air leaks in restrictive patterns, with permissive hypercapnia advised universally to prevent barotrauma.

Impact:

• Provides a framework for optimizing mechanical ventilation in critically ill infants with bronchiolitis.
• Aims to reduce ventilator-associated complications such as barotrauma, air trapping, and air leaks.
• Supports clinical decision-making for pediatric intensivists managing severe bronchiolitis cases.