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[Ventilation strategies in the child with severe hypoxemic respiratory failure]

Alejandro Donoso F1,2, Daniela Arriagada S2, Franco Díaz R1

  • 1Área de Cuidados Críticos, Unidad de Gestión Clínica del Niño, Hospital Padre Hurtado, Chile.

Gaceta Medica De Mexico
|March 6, 2015
PubMed

Insights

This review covers mechanical ventilation (MV) for pediatric acute respiratory distress syndrome (ARDS) with hypoxemia. Strategies like PEEP titration and prone positioning improve lung function and gas exchange.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Acute respiratory distress syndrome (ARDS) in children presents significant challenges, particularly with refractory hypoxemia.
  • Optimizing mechanical ventilation (MV) is crucial for managing pediatric ARDS.
  • Understanding protective ventilation strategies is essential for improving patient outcomes.

Purpose of the Study:

  • To review fundamental concepts of MV in pediatric ARDS with refractory hypoxemia.
  • To examine ventilation strategies and maneuvers for optimizing non-aerated lung tissue.
  • To discuss methods for correcting ventilation/perfusion (V/Q) mismatch.

Main Methods:

  • Review of protective ventilation concepts, including PEEP and tidal volume adjustment.
  • Analysis of alveolar recruitment maneuvers and PEEP titration.
  • Examination of high-frequency oscillatory ventilation (HFOV), airway pressure release ventilation (APRV), and prone positioning.
  • Assessment of neuromuscular blockers as a pharmacological intervention.

Main Results:

  • Protective MV involves individualized PEEP and tidal volume settings.
  • Recruitment maneuvers and PEEP downward titration can enhance lung function in ARDS.
  • Early initiation of HFOV is recommended upon failure of conventional MV.
  • Early and sustained prone positioning improves gas exchange.

Conclusions:

  • Individualized PEEP and tidal volume are key to protective MV in pediatric ARDS.
  • Recruitment maneuvers and PEEP titration offer benefits for lung function.
  • HFOV should be considered early for refractory hypoxemia.
  • Prone positioning is a valuable adjunct for improving oxygenation.

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