Author Of 1 Presentation
HIGH FREQUENCY, LOW STRETCH PRESSURE CONTROL WITH HIGH MEAN AIRWAY PRESSURE VENTILATION IN SEVERE PEDIATRIC ARDS
Abstract
Background
Pediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children (33% in severe PARDS). Lung protective ventilation strategies include low tidal volume and high-frequency ventilation, permissive hypercapnia and hypoxemia. Many institutions utilize high frequency oscillation ventilation at high mean airway pressures (MAP). An alternative strategy uses pressure control (PC) mode on a conventional ventilator with a high frequency, low tidal volume, high MAP and low FiO2.
Objectives
To demonstrate that high frequency, low stretch ventilation with higher MAP is safe in patients with severe PARDS.
Methods
This is a single center, retrospective review of patients admitted between 2011 and 2018. Patients met PALICC (Pediatric Acute Lung Injury Consensus Conference) severe PARDS definition. Ventilation followed these guidelines: (1) avoidance of oxygen toxicity (FiO2 <60%) (2) MAP titrated with PEEP to maintain PaO2 > 55 mmHg and SpO2 >88% (3) tidal volume 2-6 ml/kg (4) ventilator rates of 30 to 100/minute. Demographic, management and outcome data were collected and analyzed.
Results
In this cohort of patients (N=35), 46% were male with a mean age of 10 years and mean oxygenation index of 39 (median 30, range 16.3-125). Ventilation data (cm H2O): mean PEEP 21 (range 14-38), mean MAP 31 (range 23-47), mean driving pressure 22. Mortality was 11% and air leak requiring chest tube occurred in 6%.
Conclusion
PALICC recommends lower ventilator pressures. In this retrospective study higher airway pressures using a conventional ventilator with lung protective strategy resulted in low mortality and morbidity.
Presenter of 1 Presentation
HIGH FREQUENCY, LOW STRETCH PRESSURE CONTROL WITH HIGH MEAN AIRWAY PRESSURE VENTILATION IN SEVERE PEDIATRIC ARDS
Abstract
Background
Pediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children (33% in severe PARDS). Lung protective ventilation strategies include low tidal volume and high-frequency ventilation, permissive hypercapnia and hypoxemia. Many institutions utilize high frequency oscillation ventilation at high mean airway pressures (MAP). An alternative strategy uses pressure control (PC) mode on a conventional ventilator with a high frequency, low tidal volume, high MAP and low FiO2.
Objectives
To demonstrate that high frequency, low stretch ventilation with higher MAP is safe in patients with severe PARDS.
Methods
This is a single center, retrospective review of patients admitted between 2011 and 2018. Patients met PALICC (Pediatric Acute Lung Injury Consensus Conference) severe PARDS definition. Ventilation followed these guidelines: (1) avoidance of oxygen toxicity (FiO2 <60%) (2) MAP titrated with PEEP to maintain PaO2 > 55 mmHg and SpO2 >88% (3) tidal volume 2-6 ml/kg (4) ventilator rates of 30 to 100/minute. Demographic, management and outcome data were collected and analyzed.
Results
In this cohort of patients (N=35), 46% were male with a mean age of 10 years and mean oxygenation index of 39 (median 30, range 16.3-125). Ventilation data (cm H2O): mean PEEP 21 (range 14-38), mean MAP 31 (range 23-47), mean driving pressure 22. Mortality was 11% and air leak requiring chest tube occurred in 6%.
Conclusion
PALICC recommends lower ventilator pressures. In this retrospective study higher airway pressures using a conventional ventilator with lung protective strategy resulted in low mortality and morbidity.