Abstract
Mechanical ventilation (MV) is a lifesaving intervention for children with acute respiratory failure (ARF). However, improper application can lead to adverse outcomes, such as ventilation-induced lung injury (VILI), patient self-inflicted lung injury (P-SILI), and ventilation-induced diaphragmatic dysfunction (VIDD). This review discusses the fundamentals of MV, challenges in minimizing its side effects, and strategies to individualize therapy for pediatric patients.
Key Points
- MV in Pediatrics: MV is critical for managing pediatric ARF but carries risks if not tailored to patient-specific needs.
- Types of MV: Includes continuous mandatory ventilation (CMV), intermittent mandatory ventilation (IMV), and continuous spontaneous ventilation (CSV), with volume- or pressure-controlled settings.
- VILI Mechanisms: Comprises barotrauma, volutrauma, atelectrauma, and biotrauma, often caused by excessive pressures or tidal volumes.
- P-SILI Insights: Spontaneous, vigorous breathing in injured lungs can exacerbate stress and strain, leading to further damage, particularly in dependent lung regions.
- VIDD Risks: Prolonged MV can cause diaphragm atrophy due to disuse or injury from excessive workload, affecting extubation success.
- Lung-Protective Strategies: Includes limiting tidal volumes to 5–8 mL/kg and maintaining plateau pressures below 28 cmH₂O to minimize stress and strain.
- PEEP and Recruitment: Positive end-expiratory pressure (PEEP) prevents alveolar collapse, and recruitment maneuvers can improve ventilation distribution but require careful application to avoid overdistension.
- Monitoring Techniques: Parameters such as driving pressure, compliance, and esophageal pressure help optimize MV settings and reduce lung injury risk.
- Pediatric-Specific Challenges: Children’s lungs are more susceptible to injury, necessitating careful adherence to lung-protective ventilation principles, even in non-ARDS settings.
- Future Directions: Emphasis on integrating advanced diagnostics and personalized approaches to balance MV benefits and risks in pediatric populations.
Graphical summary of the main approaches to limiting ventilator-induced lung injury (VILI), ventilator-induced diaphragmatic dysfunction (VIDD), and patient self-inflicted lung injury (P-SILI)
Conclusion
While MV remains indispensable in pediatric critical care, its application demands precision to prevent complications like VILI, P-SILI, and VIDD. Optimizing ventilatory strategies and employing individualized care are key to achieving favorable outcomes.
Watch the following video on “Mechanical Ventilation in the PICU: Addressing Pitfalls to Optimize Patient Care by B. Walsh, et al.” by OPENPediatrics
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