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Effect of tidal volume in children with acute hypoxemic respiratory failure

Robinder G Khemani1, David Conti, Todd A Alonzo

  • 1Department of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mail Stop 12, Los Angeles, CA 90027, USA. rkhemani@chla.usc.edu

Intensive Care Medicine
|June 18, 2009
PubMed

Insights

Lung protective strategies using pressure control ventilation in children with acute hypoxemic respiratory failure (AHRF) did not show increased mortality with tidal volumes (VT) between 6-10 ml/kg. Higher VT within this range correlated with more ventilator-free days, especially in less severe cases.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Acute hypoxemic respiratory failure (AHRF) and acute lung injury (ALI) in children require mechanical ventilation.
  • Optimizing tidal volume (VT) is crucial for patient outcomes.
  • Pressure control ventilation (PCV) is a common ventilation mode.

Purpose of the Study:

  • To evaluate the effect of VT (6-10 ml/kg) during PCV on outcomes in pediatric patients with AHRF or ALI.
  • To validate lung injury severity markers: oxygenation index (OI), PaO2/FiO2 (PF) ratio, and lung injury score (LIS).

Main Methods:

  • Retrospective study of 398 mechanically ventilated children with PF ratio <300 from January 2000 to July 2007.
  • Utilized PCV in >90% of cases, targeting VT between 6-10 ml/kg.
  • Assessed outcomes including mortality and 28-day ventilator-free days.

Main Results:

  • Mortality was 20% in the study cohort.
  • VT was not significantly different between survivors and non-survivors in the initial 3 days.
  • Higher VT within the 6-10 ml/kg range was associated with more ventilator-free days (P < 0.05), particularly in patients with better respiratory system compliance.
  • OI, PF ratio, and LIS were associated with mortality (P < 0.05).

Conclusions:

  • Tidal volumes between 6-10 ml/kg during PCV in children with AHRF/ALI are not associated with increased mortality.
  • Higher VT within this range may improve ventilator-free days, especially in less severe lung disease.
  • Established lung injury markers (OI, PF ratio, LIS) remain valid predictors of mortality.
Abstract

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