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Protective Ventilation Strategies Reduce Mortality in Children With Acute Lung Injury: Presented at TCCMS

By Danny Kucharsky

TORONTO, CANADA -- November 3, 2005 -- The introduction of a lung-protective ventilation strategy in the late 1990s appears to have reduced significantly the mortality rate among children with acute lung injury, a study shows.

Presented on October 26^th at the 8^th Annual Toronto Critical Care Medicine Symposium (TCCMS), the study found that mortality among children with acute lung injury has declined by 40% since the strategy's implementation.

Lead investigator Dr. Alsharif Abdulla, MD, paediatrics fellow, Children's Hospital of Western Ontario, London, Ontario, Canada, and colleagues conducted a retrospective chart review of the management of mechanical ventilation in children with acute lung injury from 1988 to 1992 (old group) and from 2000-2004 (new group).

Dr. Abdulla noted that the lung-protective ventilation was established as a result of results from animal and clinical trials performed mainly in adults, meaning that any recommendation for mechanical ventilation in children has been extrapolated mainly from adult data. His research team therefore aimed to determine whether the introduction of a lung-protective ventilation strategy has improved outcomes in children with acute lung injury.

The analysis included children who required mechanical ventilation, who had acute onset of bilateral lung infiltrates on chest radiograph and no evidence of cardiac failure. It excluded children with underlying chronic lung disease and congenital heart disease and children without arterial blood sampling.

Overall, the researchers reviewed charts of 79 children in the old group and 85 in the recent group.

Results show that mortality was significantly greater in the old group than in the new group (35.4% vs 21.2%, respectively; P = .04).

Number of ventilation-free days was higher in the recent group compared with the past group (16 days vs 12.6 days; P = .03).

Children who had recent sepsis had a much greater chance of survival, the study also found. Only 9 of 26 (35%) children in the past group survived compared with 19 of 29 (66%) in the recent group (P = .02), who were ventilated with higher positive end expiratory pressure, lower positive inspiratory airway pressure, and lower tidal volume.

Tidal volume was found to be independently associated with increased mortality and reduction of ventilation-free days.

Dr. Abdulla concluded that adult recommendations for mechanical ventilation should be adhered to in the paediatric setting until more definitive studies are carried out in children.


[Presentation title: Protective Strategies of Ventilation Reduce Mortality Among Children With Acute Lung Injury.]

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