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Variability in usual care mechanical ventilation for pediatric acute lung injury: the potential benefit of a lung

Robinder G Khemani1, Katherine Sward, Alan Morris

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

Intensive Care Medicine
|October 4, 2011
PubMed

Insights

Pediatric intensivists often miss opportunities to reduce lung-damaging ventilator settings in children with acute lung injury (ALI). A standardized pediatric ventilation protocol could improve adherence to lung protective ventilation strategies.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Lung protective ventilation (LPV) is recommended for acute lung injury (ALI) in children.
  • However, ventilator management practices in pediatric intensive care units (PICUs) can be variable.

Purpose of the Study:

  • To describe ventilator adjustments made by clinicians for children with hypoxemic respiratory failure.
  • To evaluate the potential acceptability and impact of a pediatric mechanical ventilation protocol.

Main Methods:

  • Retrospective cohort study in a tertiary PICU (2000-2007).
  • Included mechanically ventilated children with a PaO(2)/FiO(2) ratio < 300.
  • Assessed variability by comparing actual ventilator setting changes post-arterial blood gas (ABG) to a protocol-based recommendation.

Main Results:

  • Clinicians rarely decreased FiO(2) even with high PaO(2).
  • The protocol recommended higher positive end-expiratory pressure (PEEP) than actual practice in 42-67% of cases.
  • Clinicians frequently failed to adjust peak inspiratory pressure (PIP) or ventilator rate (VR) when indicated by the protocol.

Conclusions:

  • Opportunities to minimize potentially injurious ventilator settings in pediatric ALI may be missed.
  • A standardized pediatric mechanical ventilation protocol could enhance consistency with LPV.
Abstract

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