Mechanical Ventilation Strategies in Children With Acute Lung Injury

Santschi, Miriam; Randolph, Adrienne G.; Rimensberger, Peter C.; Jouvet, Philippe

doi:10.1097/pcc.0b013e31828a89a2

Cited by 66 publications

(43 citation statements)

References 20 publications

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“…This reflects the mode with which most pediatric intensivists are traditionally comfortable with (22, 24). This utility of this mode, however, steadily declined as the disease progressed and other modes of ventilation were adopted.…”

Section: Discussionmentioning

confidence: 97%

Epidemiology of Pediatric Acute Respiratory Distress Syndrome in Singapore: Risk Factors and Predictive Respiratory Indices for Mortality

et al. 2014

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Aim: Acute respiratory distress syndrome (ARDS) represents the most severe form of acute lung injury. The aim of our study is to describe the epidemiology of pediatric ARDS in Singapore and compare the outcomes of ARDS using the following respiratory indices: PaO2/FiO2 ratio (P/F ratio), SpO2/FiO2 ratio (S/F ratio), oxygenation index (OI), and oxygen saturation index (OSI).Methods: We examined medical records of patients admitted to the Children’s Intensive Care Unit in KK Women’s and Children’s Hospital from 2009 to 2012. Those who fulfilled criteria for the American-European Consensus Conference definition for ARDS were identified. Demographic, clinical, and radiographic information were extracted and analyzed.Results: We identified 70 patients with ARDS. Median age (interquartile range) was 6.2 (1.4, 10.4) years. The most common risk factor was pneumonia [50 (71%)]. Overall mortality was 44 (63%) patients. Thirty-two (56%) patients had an underlying chronic comorbidity; 18 (46%) were hematology–oncology conditions. Fifty-six (80%) patients had multiorgan dysfunction. Adjunct therapies used in our patients included inhaled nitric oxide [5 (7%)], prone position [22 (31%)], steroids [26 (37%)], and neuromuscular blockade [26 (37%)]. A high OI and low PF ratio after 24 h of diagnosis of ARDS were associated with mortality. From day 3 onward, all four respiratory indices appropriately differentiated survivors from non-survivors. Severity based on the S/F ratio and OSI demonstrated association with decreased ventilator free days and ICU free days.Conclusion: Risk factors for mortality included having an underlying comorbidity, multiorgan dysfunction, a low PF ratio, and high OI at 24 h of ARDS. Abnormal SpO2-based measurements were reliable markers of poor outcomes in pediatric ARDS.

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Section: Discussionmentioning

confidence: 97%

Epidemiology of Pediatric Acute Respiratory Distress Syndrome in Singapore: Risk Factors and Predictive Respiratory Indices for Mortality

et al. 2014

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“…Similarly, 71% and 96% of patients had V T < 8 and 10 mL/kg, respectively. However, it is difficult to find PIP and V T above these levels in modern pediatric ARDS (9, 32). Finally, as ventilation was not protocolized, lack of association between pressure and outcome may be confounded by clinician management.…”

Section: Discussionmentioning

confidence: 99%

Disassociating Lung Mechanics and Oxygenation in Pediatric Acute Respiratory Distress Syndrome*

Yehya

Thomas

2017

Critical Care Medicine

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Objective Both oxygenation and peak inspiratory pressure (PIP) are associated with mortality in pediatric ARDS. Since oxygenation and respiratory mechanics are linked, it is difficult to identify which variables, pressure or oxygenation, are independently associated with outcome. We aimed to determine whether respiratory mechanics (PIP, positive end-expiratory pressure [PEEP], ΔP [PIP minus PEEP], tidal volume, dynamic compliance [Cdyn]) or oxygenation (PaO2/FIO2) was associated with mortality. Design Prospective, observational, cohort study. Setting University affiliated pediatric intensive care unit. Patients Mechanically ventilated children with ARDS (Berlin). Interventions None. Measurements and Main Results PIP, PEEP, ΔP, tidal volume, Cdyn, and PaO2/FIO2 were collected at ARDS onset and at 24 hours in 352 children between 2011 and 2016. At ARDS onset, neither mechanical variables nor PaO2/FIO2 were associated with mortality. At 24 hours, PIP, PEEP, ΔP were higher, and Cdyn and PaO2/FIO2 lower, in non-survivors. In multivariable logistic regression, PaO2/FIO2 at 24 hours and ΔPaO2/FIO2 (change in PaO2/FIO2 over the first 24 hours) were associated with mortality, whereas pressure variables were not. Both oxygenation and pressure variables were associated with duration of ventilation in multivariable competing risk regression. Conclusions Improvements in oxygenation, but not in respiratory mechanics, were associated with lower mortality in pediatric ARDS. Future trials of mechanical ventilation in children should focus on oxygenation (higher PaO2/FIO2) rather than lower PIP or ΔP, as oxygenation was more consistently associated with outcome.

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“…Although the Berlin definition requires a minimum PEEP of 5 cm H 2 O, other ventilator manipulations and the practice patterns around PEEP management can also alter this ratio. Consequently, differences in clinical practice may influence the diagnosis, particularly in the PICU where there is greater variability in ventilator management relative to adult ICUs (8, 9). This has led some pediatric practitioners to adopt the oxygenation index (OI) ([Fio 2 × mean airway pressure (Paw) × 100]/Pao 2 ) and oxygen saturation index (OSI) ([Fio 2 × Paw × 100]/Spo 2 ) to assess hypoxemia in children (10, 11).…”

mentioning

confidence: 99%

Pediatric Acute Respiratory Distress Syndrome

2015

Pediatric Critical Care Medicine

702

196

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Objective To describe the final recommendations of the Pediatric Acute Lung Injury Consensus Conference. Design Consensus conference of experts in pediatric acute lung injury. Setting Not applicable. Subjects PICU patients with evidence of acute lung injury or acute respiratory distress syndrome. Interventions None. Methods A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. When published, data were lacking a modified Delphi approach emphasizing strong professional agreement was used. Measurements and Main Results A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. When published data were lacking a modified Delphi approach emphasizing strong professional agreement was used. The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the following topics related to pediatric acute respiratory distress syndrome: 1) Definition, prevalence, and epidemiology; 2) Pathophysiology, comorbidities, and severity; 3) Ventilatory support; 4) Pulmonary-specific ancillary treatment; 5) Nonpulmonary treatment; 6) Monitoring; 7) Noninvasive support and ventilation; 8) Extracorporeal support; and 9) Morbidity and long-term outcomes. There were 132 recommendations with strong agreement and 19 recommendations with weak agreement. Once restated, the final iteration of the recommendations had none with equipoise or disagreement. Conclusions The Consensus Conference developed pediatric-specific definitions for acute respiratory distress syndrome and recommendations regarding treatment and future research priorities. These are intended to promote optimization and consistency of care for children with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.

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Mechanical Ventilation Strategies in Children With Acute Lung Injury

Cited by 66 publications

References 20 publications

Epidemiology of Pediatric Acute Respiratory Distress Syndrome in Singapore: Risk Factors and Predictive Respiratory Indices for Mortality

Epidemiology of Pediatric Acute Respiratory Distress Syndrome in Singapore: Risk Factors and Predictive Respiratory Indices for Mortality

Disassociating Lung Mechanics and Oxygenation in Pediatric Acute Respiratory Distress Syndrome*

Pediatric Acute Respiratory Distress Syndrome

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