The top ten unknowns in paediatric mechanical ventilation
There is inconsistent mechanical ventilation (MV) practice in children  given the fact that even today it is largely based on expert opinion and data extrapolation from adults despite the paediatric catchphrase “a child is not just a small adult”. Unique maturational differences related to lung growth and maturation (to the age of about 8 years), respiratory system development (e.g. small airways, compliant chest wall), immune response and surfactant homeostasis prevent data generated in adults being directly applicable to children. Moreover, a possible age-related susceptibility to ventilator-induced lung injury has been suggested . Furthermore, there is a much larger spectrum of pathologies associated with hypoxemic and/or hypercapnic respiratory failure in infants and children than in adults.
Given this context, we identified 10 major unknowns regarding paediatric MV in the following categories: (1) lung “protective” ventilation strategies, (2) concepts to assist...
- 1.Santschi M, Jouvet P, Leclerc F, Gauvin F, Newth CJ, Carroll CL, Flori H, Tasker RC, Rimensberger PC, Randolph AG, PALIVE Investigators, Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI), European Society of Pediatric and Neonatal Intensive Care (ESPNIC) (2010) Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med 11:681–689CrossRefPubMedGoogle Scholar
- 4.Erickson S, Schibler A, Numa A, Nuthall G, Yung M, Pascoe E, Wilkins B, Paediatric Study Group, Australian and New Zealand Intensive Care Society (2007) Acute lung injury in pediatric intensive care in Australia and New Zealand: a prospective, multicenter, observational study. Pediatr Crit Care Med 8:317–323PubMedGoogle Scholar
- 10.Bateman ST, Borasino S, Asaro LA, Cheifetz IM, Diane S, Wypij D, Curley MA, RESTORE Study Investigators (2016) Early high-frequency oscillatory ventilation in pediatric acute respiratory failure. a propensity score analysis. Am J Respir Crit Care Med 193:495–503CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Curley MA, Hibberd PL, Fineman LD, Wypij D, Shih MC, Thompson JE, Grant MJ, Barr FE, Cvijanovich NZ, Sorce L, Luckett PM, Matthay MA, Arnold JH (2005) Effect of prone positioning on clinical outcomes in children with acute lung injury: a randomized controlled trial. JAMA 294:229–237CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Wilsterman ME, de Jager P, Blokpoel R, Frerichs I, Dijkstra SK, Albers MJ, Burgerhof JG, Markhorst DG, Kneyber MC (2016) Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure. Ann Intensive Care 6:103CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Vignaux L, Grazioli S, Piquilloud L, Bochaton N, Karam O, Jaecklin T, Levy-Jamet Y, Tourneux P, Jolliet P, Rimensberger PC (2013) Optimizing patient-ventilator synchrony during invasive ventilator assist in children and infants remains a difficult task. Pediatr Crit Care Med 14:e316–e325CrossRefPubMedGoogle Scholar
- 14.Yoshida T, Uchiyama A, Matsuura N, Mashimo T, Fujino Y (2012) Spontaneous breathing during lung-protective ventilation in an experimental acute lung injury model: high transpulmonary pressure associated with strong spontaneous breathing effort may worsen lung injury. Crit Care Med 40:1578–1585CrossRefPubMedGoogle Scholar
- 17.Shah PS, Ohlsson A, Shah JP (2008) Continuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in children. Cochrane Database Syst Rev (3):CD003699Google Scholar
- 19.Newth CJ, Venkataraman S, Willson DF, Meert KL, Harrison R, Dean JM, Pollack M, Zimmerman J, Anand KJ, Carcillo JA, Nicholson CE, Eunice Shriver Kennedy National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (2009) Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med 10:1–11CrossRefPubMedPubMedCentralGoogle Scholar