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Mechanical ventilation during pediatric extracorporeal life support.
Martin C J Kneyber1,2, Ira M Cheifetz3
1Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen.
Current Opinion in Pediatrics
|July 27, 2023
Summary
Ventilator-induced lung injury (VILI) and patient self-inflicted lung injury are critical concerns in children on extracorporeal membrane oxygenation (ECMO). Optimizing mechanical ventilation strategies is essential for lung recovery in these patients.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Extracorporeal life support
Background:
- Extracorporeal membrane oxygenation (ECMO) is vital for refractory cardiorespiratory failure.
- Optimal mechanical ventilation (MV) in pediatric ARDS patients on ECMO is debated.
- Evidence often extrapolated from non-ECMO ARDS and adult populations.
Approach:
- Reviewing current understanding of VILI and P-SILI in pediatric ECMO.
- Analyzing established principles of lung-protective ventilation.
- Discussing individualized approaches to MV settings and spontaneous breathing.
Key Points:
- Limiting inspiratory and driving pressures is a minimum standard.
- Adequate positive end-expiratory pressure (PEEP) and low respiratory rates reduce mechanical power.
- Individualized spontaneous breathing trials and pulmonary treatments are crucial.
- Balancing risks and benefits of MV strategies is paramount.
Conclusions:
- Further research is needed to define optimal MV strategies for pediatric ECMO.
- Reducing mechanical ventilation intensity is key to decreasing VILI and promoting lung recovery.
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