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Tidal volume and mortality in mechanically ventilated children: a systematic review and meta-analysis of
Pauline de Jager1, Johannes G M Burgerhof, Marc van Heerde
11Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands. 2Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands. 3Department of Paediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands. 4St. Elisabeth Hospital, Tilburg, The Netherlands. 5Critical Care, Anaesthesiology, Peri-operative Medicine and Emergency Medicine, the University of Groningen, Groningen, The Netherlands.
Insights
This study found no link between tidal volume settings and mortality in critically ill children on mechanical ventilation. Further research is needed due to observed heterogeneity in outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Clinical Epidemiology
Background:
- Mechanical ventilation is crucial for critically ill children.
- Tidal volume (TV) is a key ventilator setting.
- The association between TV and mortality in pediatric intensive care unit (PICU) patients remains unclear.
Purpose of the Study:
- To investigate the relationship between tidal volume and mortality in critically ill children receiving mechanical ventilation.
- To synthesize existing evidence on this association.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials and observational studies.
- Searched MEDLINE, EMBASE, and CINAHL databases.
- Included studies reporting mortality in mechanically ventilated PICU patients.
Main Results:
- Eight studies with 1,756 patients were included.
- No association was found between tidal volume and mortality across various dichotomized thresholds (7, 8, 10, 12 mL/kg).
- Analysis in patients with acute lung injury/acute respiratory distress syndrome also showed no association; significant heterogeneity was noted.
Conclusions:
- Tidal volume settings did not appear to be associated with mortality in mechanically ventilated children.
- Significant heterogeneity in pooled analyses highlights the need for future studies.
- Well-defined pediatric populations are required for future research on tidal volume's impact.
Objective:
To determine whether tidal volume is associated with mortality in critically ill, mechanically ventilated children.
Data Sources:
MEDLINE, EMBASE, and CINAHL databases from inception until July 2013 and bibliographies of included studies without language restrictions.
Study Selection:
Randomized clinical trials and observational studies reporting mortality in mechanically ventilated PICU patients.
Data Extraction:
Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes. Meta-analyses were performed using the Mantel-Haenszel random-effects model. Heterogeneity was quantified using I. Study quality was assessed using the Newcastle-Ottawa Score for cohort studies.
Data Synthesis:
Out of 142 citations, seven studies met the inclusion criteria, and additional two articles were identified from references of the found articles. One was excluded. These eight studies included 1,756 patients. Mortality rates ranged from 13% to 42%. There was no association between tidal volume and mortality when tidal volume was dichotomized at 7, 8, 10, or 12 mL/kg. Comparing patients ventilated with tidal volume less than 7 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg and tidal volume less than 8 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg also showed no association between tidal volume and mortality. Limiting the analysis to patients with acute lung injury/acute respiratory distress syndrome did not change these results. Heterogeneity was observed in all pooled analyses.
Conclusions:
A relationship between tidal volume and mortality in mechanically ventilated children could not be identified, irrespective of the severity of disease. The significant heterogeneity observed in the pooled analyses necessitates future studies in well-defined patient populations to understand the effects of tidal volume on patient outcome.
