Are We Using a Lung Protective Strategy in Our Mechanically Ventilated Pediatric Patients?

SESSION TITLE: Respiratory Support PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Our aims were to evaluate the tidal volume selection in a group of mechanically ventilated pediatric patients and to determine if a low VTstrategy was used when patients receive high oxygen requirements.METHODS: This was a retrospective cohort study in a single Medical-Surgical PICU during a three-month period. We included patients younger than 18 years of age who required mechanical ventilation for more than 24 hours. The ventilatory parameters measured included VT, respiratory rate, FiO2, minute ventilation, PEEP, and ABW. VT was adjusted according to the ABW according to the pediatric literature/current practice. The independent variable was a lung protective strategy defined as a VT of 6-8 mL/kg adjusted for ABW. The primary outcome was the "high oxygen need" defined as a FiO2 >50% and/or a PEEP >5 cmH2O requirement.RESULTS: We selected 64 patients who received invasive mechanical ventilation for > 12 h over the study period. The mean VT selected for these patients based on ABW was 8.9 + 1.5 mL/kg (range: 6 mL/kg - 13.3 mL/kg). A total of 21 patients (32.8%) received a VT of 6-8 mL/kg while 67.2% were set at a VT > 8 mL/kg. Patients on VT > 10 mL/kg and > 12 mL/kg represented 14% and 3%, respectively. The single most often selected VT was 10 mL/kg (n=17; 26.6%). Twenty patients (31.3%) were on PEEP > 5 cm H2O while 29 (45.3%) required FiO2 > .50. Patients on "high oxygen need" represented 20.3% (n=13) of the study population. High oxygen need was not associated with the use of a lung protective strategy (OR 1.3; 95% CI 0.4 - 3.6; p=0.66).CONCLUSIONS: The majority of the patients in this study were ventilated with VT outside of the range typically considered in a low tidal volume strategy. The presence of high oxygen need was not associated with the use of a lung protective strategy among children requiring mechanical ventilation. Future quality improvement strategies should focus on determining the application of low tidal volume strategies in children who require mechanical ventilation.CLINICAL IMPLICATIONS: Determining tidal volume for pediatric patients requiring mechanical ventilation is often based on actual body weight (ABW), unless malnutrition or obesity are present. A lung protective strategy that includes a low tidal volume has become the preferred method of delivering mechanical ventilation in patients with acute respiratory failure. However, limited data are available regarding tidal volume selection in pediatric patients requiring mechanical ventilation despite the admission diagnosis.DISCLOSURE: The following authors have nothing to disclose: Lorena Fernandez-Restrepo, Minnette Son, Ruben Restrepo, Marcos RestrepoNo Product/Research Disclosure Information.