Conventional mechanical ventilation in pediatrics.

Published

Journal Article (Review)

OBJECTIVE:To review the various challenges of providing mechanical ventilation to pediatric patients with diseases of increased airway resistance, diseases of abnormal lung compliance or normal lungs. SOURCES:Original data from our pediatric intensive care unit and animal research laboratory. Relevant articles included in the MEDLINE electronic database during the last 10 years. Also included were book chapters and definitive studies, as judged by the authors, in the fields of asthma, acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury and permissive hypercapnia. SUMMARY OF THE FINDINGS:Mechanical ventilation of patients with diseases of increased airway resistance should center on avoidance of dynamic hyperinflation, allowing complete exhalation prior to the initiation of a subsequent breath and permissive hypercapnia. Positive end-expiratory pressure should be used sparingly to prevent atelectasis and facilitate synchrony in spontaneously breathing patients. Mechanical ventilation of patients with diseases of abnormal lung compliance should take into consideration the inhomogeneous distribution of lung disease. Focus should be on avoidance of volutrauma and atelectrauma that could result in ventilator-associated lung injury. CONCLUSIONS:The last decade was marked by significant advances in the management of pediatric respiratory failure. The choice of mechanical ventilation strategy can significantly influence the subsequent course of lung injury. Mechanical ventilation can no longer be viewed simply as a harmless support modality that is employed to keep patients alive while disease-specific treatments are used to ameliorate the underlying pathology.

Full Text

Duke Authors

Cited Authors

  • Rotta, AT; Steinhorn, DM

Published Date

  • May 15, 2007

Published In

Volume / Issue

  • 83 / 2 Suppl

Start / End Page

  • S100 - S108

PubMed ID

  • 17508092

Pubmed Central ID

  • 17508092

Electronic International Standard Serial Number (EISSN)

  • 1678-4782

International Standard Serial Number (ISSN)

  • 0021-7557

Digital Object Identifier (DOI)

  • 10.2223/jped.1617

Language

  • eng