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Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome

Judith Ju Ming Wong1,2, Siew Wah Lee1,3, Herng Lee Tan1

  • 1Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 25, 2020
PubMed

Insights

Implementing a lung-protective mechanical ventilation protocol in pediatric acute respiratory distress syndrome improved adherence to lung-protective strategies. This approach may potentially reduce mortality in critically ill children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Lung-protective mechanical ventilation (LPMV) is standard in adults with acute respiratory distress syndrome (ARDS), but its benefit in pediatric ARDS (PARDS) remains unproven.
  • This study investigates the impact of an LPMV protocol on clinical outcomes in children with PARDS.

Purpose of the Study:

  • To determine if a lung-protective mechanical ventilation protocol is associated with improved clinical outcomes in pediatric acute respiratory distress syndrome.
  • To assess adherence to LPMV strategies and their effect on mortality and other relevant parameters.

Main Methods:

  • A before-and-after pilot study design was employed from April 2016 to September 2019.
  • Patients admitted to the multidisciplinary Pediatric Intensive Care Unit (PICU) meeting the Pediatric Acute Lung Injury Consensus Conference criteria for ARDS were included.
  • The LPMV protocol incorporated specific targets for peak pressures, tidal volumes, PEEP/FiO2 ratios, permissive hypercapnia, and permissive hypoxemia.

Main Results:

  • The study compared outcomes between a protocol group (n=63) and a non-protocol group (n=69).
  • Implementation of the LPMV protocol led to adherence with lung-protective measures, including lower median tidal volumes and higher PEEP and PaCO2.
  • While no significant difference in in-hospital mortality was observed initially (15.9% vs 26.1%), adjusted analysis revealed a significant decrease in mortality associated with the LPMV protocol (adjusted hazard ratio, 0.37).
  • No significant differences were found in ventilator-free days or PICU-free days between the groups.

Conclusions:

  • A lung-protective mechanical ventilation protocol in pediatric acute respiratory distress syndrome demonstrated improved adherence to lung-protective strategies.
  • The protocol was associated with a potential reduction in mortality, suggesting its clinical utility in managing PARDS.
  • Further research is warranted to confirm these findings in larger cohorts.
Abstract

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