Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Rimensberger, Peter C.; Cheifetz, Ira M.

doi:10.1097/pcc.0000000000000433

Cited by 125 publications

(68 citation statements)

References 82 publications

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“…They recommend that in patients in controlled mechanical ventilation modes, using tidal volumes in or below the physiologic range for age and body weight; that is 5–8mL/kg IBW. Furthermore, tidal volume should be adjusted with disease severity, with even lower volumes of 3–6mL/kg IBW for patients with poor respiratory system compliance(22). Both these recommendations received approximately 80% agreement between the consensus members, with all members calling for more robust research to evaluate the impact of tidal volume on outcomes in children with PARDS.…”

Section: Discussionmentioning

confidence: 99%

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome*

Ward

Quinn

Valentine

et al. 2016

Pediatric Critical Care Medicine

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Objective To determine the frequency of low tidal volume ventilation (LTVV) in pediatric acute respiratory distress syndrome (PARDS), and assess if any demographic or clinical factors improve LTVV adherence. Design Descriptive post-hoc analysis of 4 multicenter PARDS studies Setting 26 academic pediatric intensive care units Patients 315 PARDS patients Measurements and Main Results All patients who received conventional mechanical ventilation at hours 0 and 24 of PARDS who had data to calculate ideal body weight (IBW) were included. Two cutoff points for LTVV were assessed: ≤6.5mL/kg IBW and ≤8mL/kg IBW. Of 555 patients, we excluded 240 for other respiratory support modes or missing data. The remaining 315 patients had a median PF ratio of 140 (IQR 90–201), and there were no differences in demographics between those who did and did not receive LTVV. With TV cutoff of ≤6.5mL/kg IBW, the adherence rate was 32% at hour 0 and 33% at hour 24. A LTVV cutoff of TV ≤8mL/kg IBW resulted in an adherence rate of 58% at hour 0 and 60% at hour 24. LTVV use was no different by severity of PARDS nor did adherence improve over time. At hour 0, overweight children were less likely to receive LTVV ≤6.5mL/kg IBW (11% overweight vs 38% non-overweight, p=0.02); no difference was noted by hour 24. Furthermore, in the overweight group, using admission weight instead of IBW resulted in misclassification of up to 14% of patients as receiving LTVV when they actually were not. Conclusions LTVV is underused in the first 24 hours of PARDS. Age, PRISM-III, and PARDS severity were not associated with improved LTVV adherence, nor did adherence improve over time. Overweight children were less likely to receive LTVV strategies in the first day of illness.

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Section: Discussionmentioning

confidence: 99%

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome*

Ward

Quinn

Valentine

et al. 2016

Pediatric Critical Care Medicine

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“…Indeed, a decrease in driving pressure concomitant to a reduction in tidal volume or an increase in PEEP were associated with increased survival, while differences in tidal volume were not associated with different survival rates when the driving pressure was constant 5 . In ARDS, the proportion of lung available for ventilation is markedly decreased; therefore, the driving pressure (and consequently tidal volume) should be adapted to this reality rather than using only predicted body weight 11 . However, it is important to note that this approach should be adapted depending on the patient’s condition.…”

Section: Advances In Optimization and Customization Of Mechanical Venmentioning

confidence: 99%

Recent Advances in Pediatric Ventilatory Assistance

et al. 2017

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In this review on respiratory assistance, we aim to discuss the following recent advances: the optimization and customization of mechanical ventilation, the use of high-frequency oscillatory ventilation, and the role of noninvasive ventilation. The prevention of ventilator-induced lung injury and diaphragmatic dysfunction is now a key aspect in the management of mechanical ventilation, since these complications may lead to higher mortality and prolonged length of stay in intensive care units. Different physiological measurements, such as esophageal pressure, electrical activity of the diaphragm, and volumetric capnography, may be useful objective tools to help guide ventilator assistance. Companies that design medical devices including ventilators and respiratory monitoring platforms play a key role in knowledge application. The creation of a ventilation consortium that includes companies, clinicians, researchers, and stakeholders could be a solution to promote much-needed device development and knowledge implementation.

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“…So far, management of these children has been confined to a lung-protective mechanical ventilation (MV) strategy entailing low tidal volume ( V T ) of 6 mL/kg body weight, limiting peak inspiratory pressure (PIP) and/or plateau pressure ( P plat ) to 30 cmH 2 O and the application of positive end-expiratory pressure (PEEP) [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

Wilsterman

Jager

Blokpoel

et al. 2016

Ann. Intensive Care

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BackgroundNeuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume V T toward non-dependent lung zones.MethodsOxygenation index, PaO2/FiO2 ratio, lung mechanics (plateau pressure, mean airway pressure, respiratory system compliance and resistance), hemodynamics (heart rate, central venous and arterial blood pressures), oxygenation [oxygenation index (OI), PaO2/FiO2 and SpO2/FiO2], ventilation (physiological dead space-to-V T ratio) and electrical impedance tomography measured changes in end-expiratory lung volume (EELV), and V T distribution was measured before and 15 min after the start of continuous infusion of rocuronium 1 mg/kg. Patients were ventilated in a time-cycled, pressure-limited mode with pre-set V T. All ventilator settings were not changed during the study.ResultsTwenty-two patients were studied (N = 18 met the criteria for pediatric ARDS). Median age (25–75 interquartile range) was 15 (7.8–77.5) weeks. Pulmonary pathology was present in 77.3%. The median lung injury score was 9 (8–10). The overall median CoV and regional lung filling characteristics were not affected by NMB, indicating no ventilation shift toward the non-dependent lung zones. Regional analysis showed a homogeneous time course of lung inflation during inspiration, indicating no tendency to atelectasis after the introduction of NMB. NMB decreased the mean airway pressure (p = 0.039) and OI (p = 0.039) in all patients. There were no significant changes in lung mechanics, hemodynamics and EELV. Subgroup analysis showed that OI decreased (p = 0.01) and PaO2/FiO2 increased (p = 0.02) in patients with moderate or severe PARDS.ConclusionsNMB resulted in an improved oxygenation index in pediatric patients with AHRF. Distribution of V T and regional lung filling characteristics were not affected.

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Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome

Cited by 125 publications

References 82 publications

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome*

Poor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome*

Recent Advances in Pediatric Ventilatory Assistance

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure

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