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Pressure-controlled ventilation in children with severe status asthmaticus
Ashok P Sarnaik1, Kshama M Daphtary, Kathleen L Meert
1Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI 48201, USA. Asarnaik@med.wayne.edu
Summary
Pressure-controlled ventilation effectively manages severe pediatric status asthmaticus, improving blood gases and ensuring survival. This mechanical ventilation strategy offers a valuable option for children with severe respiratory failure.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- The optimal mechanical ventilation strategy for pediatric status asthmaticus remains undefined.
- Volume-controlled ventilation is the traditional method, but pressure-controlled ventilation may offer more uniform lung inflation.
Purpose of the Study:
- To evaluate the effectiveness of pressure-controlled ventilation (PCV) as an initial strategy for children with severe respiratory failure due to status asthmaticus.
Main Methods:
- Retrospective review of patients in a pediatric intensive care unit.
- PCV was initiated, with settings adjusted based on blood gas values, flow waveform, and exhaled tidal volume.
Main Results:
- In 40 patients (51 episodes), PCV improved median pH from 7.21 to 7.31 and decreased median Pco(2) from 65 to 41 torr within 4 hours.
- Oxygen saturation remained >95% in all patients; complications included pneumomediastinum, pneumothorax, and subcutaneous emphysema.
- All patients survived without neurologic complications, with a median mechanical ventilation duration of 29 hours.
Conclusions:
- Pressure-controlled ventilation appears to be an effective strategy for managing severe pediatric status asthmaticus.
- PCV offers a viable therapeutic option for children experiencing severe respiratory failure from status asthmaticus.