Influence of low volume-pressure limited ventilation on outcome of severe paediatric pulmonary diseases

Summary

To examine the influence of low volume-pressure limited ventilation (LVPLV) on mortality and mechanical ventilation (MV)-induced lung injury we report on a retrospective, cohort study done in a paediatric intensive care unit (PICU) in a tertiary care children's hospital. Patients studied were a consecutive series of 100 critically-ill children, receiving MV for severe respiratory diseases between 1985 and 1996. LVPLV strategies were used during the last 6 years (1991–96), compared with conventional ventilatory support used during the previous 6 year period (1985–90). Comparison of data between the two periods of the study showed that the survival rate increased from 57% to 84% (p < 0.003), whereas the air-leak frequency declined significantly (27% versus 8%, p < 0.02). These changes were preceded by a significant reduction in the maximum tidal volumes (V_T 12.1 versus 8.97 ml-kg⁻¹, p = 0.001), corresponding to higher longitudinal maximum PaCO₂ values (59.4 versus 68 mmHg, p = 0.003). These results indicate that LVPLV, adjusted to deliver a lower level of ventilatory support by simple modifications of basic mechanical ventilation modalities, might have the potential to improve the outcome of children with severe parenchymal lung diseases.

Key Words:

• mechanical ventilation
• children
• critical illness
• adult respiratory distress syndrome
• air leak