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Intensive Care Medicine

, Volume 35, Issue 8, pp 1428–1437 | Cite as

Effect of tidal volume in children with acute hypoxemic respiratory failure

  • Robinder G. Khemani
  • David Conti
  • Todd A. Alonzo
  • Robert D. BartIII
  • Christopher J. L. Newth
Pediatric Original

Abstract

Objectives

To determine if tidal volume (V T) between 6 and 10 ml/kg body weight using pressure control ventilation affects outcome for children with acute hypoxemic respiratory failure (AHRF) or acute lung injury (ALI). To validate lung injury severity markers such as oxygenation index (OI), PaO2/FiO2 (PF) ratio, and lung injury score (LIS).

Design

Retrospective, January 2000–July 2007.

Setting

Tertiary care, 20-bed PICU.

Patients

Three hundred and ninety-eight endotracheally intubated and mechanically ventilated children with PF ratio <300. Outcomes were mortality and 28-day ventilator free days.

Measurements and main results

Three hundred and ninety-eight children met study criteria, with 20% mortality. 192 children had ALI. Using >90% pressure control ventilation, 85% of patients achieved V T less than 10 ml/kg. Median V T was not significantly different between survivors and non-survivors during the first 3 days of mechanical ventilation. After controlling for diagnostic category, age, delta P (PIP-PEEP), PEEP, and severity of lung disease, V T was not associated with mortality (P > 0.1), but higher V T at baseline and on day 1 of mechanical ventilation was associated with more ventilator free days (P < 0.05). This was particularly seen in patients with better respiratory system compliance [Crs > 0.5 ml/cmH20/kg, OR = 0.70 (0.52, 0.95)]. OI, PF ratio, and LIS were all associated with mortality (P < 0.05).

Conclusions

When ventilating children using lung protective strategies with pressure control ventilation, observed V T is between 6 and 10 ml/kg and is not associated with increased mortality. Moreover, higher V T within this range is associated with more ventilator free days, particularly for patients with less severe disease.

Keywords

Pediatrics Positive pressure respiration Lung volume measurements 

Notes

Acknowledgments

Christopher J. L. Newth was partially supported by NIH 5U10 HD050012-04.

Supplementary material

134_2009_1527_MOESM1_ESM.doc (95 kb)
(DOC 95 kb)

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Robinder G. Khemani
    • 1
    • 2
  • David Conti
    • 2
  • Todd A. Alonzo
    • 2
  • Robert D. BartIII
    • 1
    • 2
  • Christopher J. L. Newth
    • 1
    • 2
  1. 1.Department of Anesthesia and Critical Care MedicineChildren’s Hospital Los AngelesLos AngelesUSA
  2. 2.Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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