Acute lung injury in pediatric intensive care in Australia and New Zealand–A prospective, multicenter, observational study*

Erickson, Simon; Schibler, Andreas; Numa, Andrew; Nuthall, Gabrielle; Yung, Michael; Pascoe, Elaine M.; Wilkins, Barry

doi:10.1097/01.pcc.0000269408.64179.ff

Cited by 229 publications

(293 citation statements)

References 42 publications

(35 reference statements)

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“…Other several pediatric investigators have demonstrated stronger associations between OI and mortality for each day the patient remains on mechanical ventilation 53,54 . Data from two pediatric studies 11,55 suggested that OI may have better discriminatory value for mortality than PaO 2 / FiO 2 , and the relationship between OI and mortality strengthens as the patient remains on mechanical ventilation for the first 3 days 55 .…”

Section: Volume 59 • Number 2 Hfo Versus CMV In Pediatric Ardsmentioning

confidence: 99%

“…Reasons for that large variation may include major differences in demographics and healthcare delivery systems 9 . In pediatrics, the prevalence of ARDS is 2-12.8 per 100,000 person years [10][11][12] .…”

mentioning

confidence: 99%

“…High frequency oscillation appeared as an alternative technique of ventilation in which extremely small tidal volumes (1-3 ml/kg) are delivered at high frequencies (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) with an oscillatory pump and constant lung recruitment 26 , hence it meets theoretically the goals of a strategy of lung protective ventilation 27 .…”

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confidence: 99%

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High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

et al. 2017

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Although the HFO mode appeared to be a safe mode with a significant better oxygenation improvement (after the first 24 hours) and fewer crossover rates, it failed to show differences as regards mortality or LOS when compared to the CMV adopting protective lung strategy. In PARDS, HFO had a superior advantage in improving oxygenation, yet with no significant mortality improvement, as multi-organ dysfunction syndrome (MODS) was the most common cause of death in our study and not refractory hypoxemia which is the main problem in PARDS; highlighting that mortality in PARDS is multi-factorial and may not depend only on how fast oxygenation improves.

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Section: Volume 59 • Number 2 Hfo Versus CMV In Pediatric Ardsmentioning

confidence: 99%

mentioning

confidence: 99%

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High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

et al. 2017

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“…Although pediatric data are only observational, [34][35][36] it is important to review the recent publication by Amato et al 12 describing the association between the driving pressure and survival in adults with ARDS. Among ventilation parameters, the drive pressure (difference between peak inspiratory pressure and positive end-expiratory pressure) was most strongly associated with survival.…”

Section: Lung-protective Ventilationmentioning

confidence: 99%

Year in Review 2015: Pediatric ARDS

Cheifetz

2016

Respir Care

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Led by the work of the Pediatric Acute Lung Injury Consensus Conference, much was published on the topic of pediatric ARDS in 2015. Although the availability of definitive data to the pediatric practitioner for the management of infants and children with pediatric ARDS continues to lag behind that for the adult clinician, 2015 augmented the available medical literature with more information than had been seen for years. This article will review key pediatric ARDS publications with a focus on the Pediatric Acute Lung Injury Consensus Conference consensus definition, sedation management, use of high-frequency oscillatory ventilation, diagnosis of delirium, noninvasive respiratory support, lung-protective ventilation, and adjunct management therapies. Despite the recent progress, additional investigation in each of these areas is essential to the continued advancement of our knowledge and, more importantly, improvements in the outcome for pediatric patients with ARDS.

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“…22 The use of HFOV in pediatric critical care varies between 3% and 30% of all ventilated children. [23][24][25][26][27] This relatively low use may be explained by several factors. First, lack of equipment or disbelief of the attending physician because of the absence of sound evidence of effect.…”

Section: Introductionmentioning

confidence: 99%

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

2012

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Mechanical ventilation using low tidal volumes has become universally accepted to prevent ventilator-induced lung injury. High-frequency oscillatory ventilation (HFOV) allows pulmonary gas exchange using very small tidal volume (1-2 mL/kg) with concomitant decreased risk of atelectrauma. However, its use in pediatric critical care varies between only 3% and 30% of all ventilated children. This might be explained by the fact that the beneficial effect of HFOV on patient outcome has not been ascertained. Alternatively, in contrast with present recommendations, one can ask if HFOV has been employed in its most optimal fashion related especially to the indications for and timing of HFOV, as well as to using the best oscillator settings. The first was addressed in one small randomized study showing that early use of HFOV, instead of rescue use, was associated with improved survival. From a physiologic perspective, the oscillator settings could be refined. Lung volume is the main determinant of oxygenation in diffuse alveolar disease, suggesting using an open-lung strategy by recruitment maneuvers, although this is in practice not custom. Using such an approach, the patient can be oscillated on the deflation limb of the pressurevolume (P-V) curve, allowing less pressure required to maintain a certain amount of lung volume. Gas exchange is determined by the frequency and the oscillatory power setting, controlling the magnitude of the membrane displacement. Experimental work as well as preliminary human data have shown that it is possible to achieve the smallest tidal volume with concomitant adequate gas exchange when oscillating at high frequency and high fixed power setting. Future studies are needed to validate these novel approaches and to evaluate their effect on patient outcome.

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Acute lung injury in pediatric intensive care in Australia and New Zealand–A prospective, multicenter, observational study*

Abstract: ALI in children is uncommon but has a high mortality rate. Risk factors for mortality are easily identified. Ventilatory variables and indexes of lung severity were significantly associated with mortality.

Cited by 229 publications

References 42 publications

High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

High frequency oscillatory ventilation versus conventional mechanical ventilation in pediatric acute respiratory distress syndrome: A randomized controlled study

Year in Review 2015: Pediatric ARDS

Reflections on Pediatric High-Frequency Oscillatory Ventilation From a Physiologic Perspective

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