Related Experiment Videos
Have changes in ventilation practice improved outcome in children with acute lung injury?
Waleed H Albuali1, Ram N Singh, Douglas D Fraser
1Department of Pediatrics and Pediatric Critical Care Unit, Children's Hospital of Western Ontario, London Health Sciences Center, University of Western Ontario, London, ON, Canada.
Objectives:
To describe the changes that have occurred in mechanical ventilation in children with acute lung injury in our institution over the last 10-15 yrs and to examine the impact of these changes, in particular of the delivered tidal volume on mortality.
Design:
Retrospective study.
Setting:
University-affiliated children's hospital.
Patients:
The management of mechanical ventilation between 1988 and 1992 (past group, n = 79) was compared with the management between 2000 and 2004 (recent group, n = 85).
Interventions:
None.
Measurements And Main Results:
The past group patients were ventilated with a significantly higher mean tidal volume (10.2 +/- 1.7 vs. 8.1 +/- 1.4 mL.kg actual body weight, p < .001), lower levels of positive end-expiratory pressure (6.1 +/- 2.7 vs. 7.1 +/- 2.4 cm H2O, p = .007), and higher mean peak inspiratory pressure (31.5 +/- 7.3 vs. 27.8 +/- 4.2 cm H2O, p < .001) than the recent group patients. The recent group had a lower mortality (21% vs. 35%, p = .04) and a greater number of ventilator-free days (16.0 +/- 9.0 vs. 12.6 +/- 9.9 days, p = .03) than the past group. A higher tidal volume was independently associated with increased mortality (odds ratio 1.59; 95% confidence interval 1.20, 2.10, p < .001) and reduction in ventilation-free days (95% confidence interval -1.24, -0.77, p < .001).
Conclusions:
The changes in the clinical practice of mechanical ventilation in children in our institution reflect those reported for adults. In our experience, mortality among children with acute lung injury was reduced by 40%, and tidal volume was independently associated with reduced mortality and an increase in ventilation-free days.
Related Concept Videos
Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Cardiopulmonary Resuscitation II: ACLS Airway Management
Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
Acute Respiratory Failure-IV
Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)