Mechanical Ventilation in Children – Problems and Issues

Abstract

Respiratory failure is the leading reason for the admission of children to intensive care units, and the ventilator is the main therapeutic tool used during the treatment of these patients. A competently used ventilator and adequate knowledge of the anatomy, histology and physiology of the respiratory system in particular age groups of children (especially among neonates and infants) are crucial for successful treatment. Both non-invasive and invasive ventilation modes can be used for respiratory treatment in children. Invasive ventilation modes can be divided into two groups: conventional ones such as pressure-controlled or volume-controlled ventilation, or non-conventional modes such as oscillatory ventilation. Mechanical ventilation can involve a high risk of serious complications, such as pressure injury (barotrauma), volume injury (volutrauma) and biotrauma. Adhering to the principles of lung-protective ventilation can reduce the risk of side effects of mechanical ventilation (Adv Clin Exp Med 2014, 23, 5, 843-848).

Negative-Pressure Ventilation in Pediatric Acute Respiratory Failure

“…1 Patients with ARF are commonly managed with supraphysiologic oxygen, high rates of flow, and air pressure delivered through invasive and noninvasive modalities, all with inherent risks and clinical implications. 2 Invasive positive-pressure ventilation is independently associated with increased lengths of stay and risk of bacterial pneumonia, requires intravenous sedation, and can precipitate lung injury. The damage from invasive ventilation is due to the delivery of positive pressure in a nonphysiologic way, causing barotrauma from excessive pressures, volutrauma from excessive tidal volumes, and atelectrauma from heterogeneous tidal volume delivery.…”

Massive pulmonary hemorrhage before living donor liver transplantation in infants

“…Conversely, mechanical ventilation with an excessive positive pressure carries the risk of barotrauma. To protect the lung from barotrauma, the value of the PIP should not exceed 30 cmH 2 O and the PEEP level should range from 5 to 15 cmH 2 O . In our present cases, the maximum PIP and PEEP were 38/14 cmH 2 O and 55/15 cmH 2 O, respectively.…”

Risk Factors for Mortality in Children with Hospital-Acquired Pneumonia in Dr. Soetomo General Hospital Surabaya

“…The dependence promoted barotrauma, volumtrauma, or biotrauma, which lead to dangerous complication such as bronchopulmonary dysplasia (BPD). 29 The last, response to therapy was found to have association with mortality. The conditions that would likely lead to mortality were acting the same as deterioration factor that worsen patients' clinical state in early treatment.…”