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Invasive ventilation modes in children: a systematic review and meta-analysis
Anita Duyndam1, Erwin Ista, Robert Jan Houmes
1Intensive Care Unit, Erasmus MC - Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
Critical Care (London, England)
|January 19, 2011
Summary
This review found no significant differences in mortality or ventilation duration across various artificial respiration modes in children. High-frequency ventilation showed improved oxygenation but not reduced mortality.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Evidence-based medicine
Background:
- Mechanical ventilation is crucial for critically ill children.
- Optimal ventilation mode selection remains a challenge, especially beyond the neonatal period.
- Limited comparative data exists for pediatric ventilation strategies.
Purpose of the Study:
- To critically review evidence on artificial respiration modes for children up to 18 years.
- To compare the efficacy of different ventilation modes based on key clinical outcomes.
Main Methods:
- Systematic literature search of PubMed and EMBASE databases.
- Inclusion of randomized controlled trials comparing two ventilation modes.
- Analysis of outcomes including length of ventilation, oxygenation, mortality, and weaning.
Main Results:
- Five trials involving 421 children compared six ventilation modes (HFO, PC, PS, VS, VDR, biphasic positive airway pressure).
- No significant differences were found in length of ventilation or mortality.
- High-frequency ventilation (HFO, VDR) demonstrated improved oxygenation compared to conventional methods.
Conclusions:
- Scarce data exists for optimal ventilation modes in critically ill children post-newborn period.
- Current evidence does not support high-frequency ventilation for reduced mortality or ventilation duration.
- Future research should focus on long-term outcomes like pulmonary function and neurocognitive development.
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