Paediatric ventilation treatment of acute lung injury in Nordic intensive care units

Abstract

Background: Treatment of acute respiratory distress syndrome (ARDS) in children is largely based on extrapolated knowledge obtained from adults and which varies between different hospitals. This study explores ventilation treatment strategies for children with ARDS in the Nordic countries, and compares these with international practice. Methods: In October 2012, a questionnaire covering ventilation treatment strategies for children aged 1 month to 6 years of age with ARDS was sent to 21 large Nordic intensive care units that treat children with ARDS. Pre-terms and children with congenital conditions were excluded. Results: Eighteen of the 21 (86%) targeted intensive care units responded to the questionnaire. Fifty per cent of these facilities were paediatric intensive care units. Written guidelines existed in 44% of the units. Fifty per cent of the units frequently used cuffed endotracheal tubes. Ventilation was achieved by pressure control for 89% vs. volume control for 11% of units. Bronchodilators were used by all units, whereas steroids usage was 83% and surfactant 39%. Inhaled nitric oxide and high frequency oscillation were available in 94% of the units. Neurally adjusted ventilator assist was used by 44% of the units. Extracorporeal membrane oxygenation could be started in 44% of the units. Conclusion: Ventilation treatment strategies for paediatric ARDS in the Nordic countries are relatively uniform and largely in accordance with international practice. The use of steroids and surfactant is more frequent than shown in other studies.

Paediatric ventilation survey: the result of warm winds blowing in the Scandinavian countries

“…The 2 years fellowship combines clinical training, clinical rotations, systematic theoretical curriculum and academic projects with networking within the Nordic countries. The current survey is an excellent example on how to use the fellowship and network of fellows and local mentors to monitor quality and thereby improve patient care . The response rate of 86% of the survey was reasonably high indicating support from the Nordic university hospitals to such initiatives.…”

“…Children undergoing cardiac surgery or neurosurgery are treated either in mixed PICU or in adult cardiac‐surgical or neurosurgical ICU. According to the present survey, children with ARDS aged between 1 month and up to 6 years were mainly treated either in the PICUs or adult ICU . Traditionally, adult ICUs and PICUs are managed by anaesthesiologists in the Scandinavian countries, but in some institution paediatricians are in charge.…”

“…Outcome data in paediatric intensive care medicine is sparse, and the evidence behind a specific treatment and clinical recommendations is often extrapolated from adult or animal studies. In this issue of Acta Anaesthesiologica Scandinavica , Jensen LL et al present the clinical practice of treating Acute Respiratory Distress Syndrome (ARDS) in children in the Nordic countries . The study shows that ventilation treatment strategies for paediatric ARDS in larger intensive care units (ICU) and paediatric intensive care units (PICU) in the Nordic countries are relatively uniform and in accordance with international recommendations.…”

“…Traditionally, adult ICUs and PICUs are managed by anaesthesiologists in the Scandinavian countries, but in some institution paediatricians are in charge. When treating a child in adult ICU, the responsibility of treatment is often shared with paediatricians …”

“…At the beginning of each fellowship programme the candidates are allocated to specific academic tasks under supervision of mentors from the programme steering committee. From the previous SSAI training programme in paediatric anaesthesia (2011–2013), two out of three groups have published their results in international journals . The participants of the current fellowship rotation (2013–2015) will present the results of their study projects at the 33rd congress of the SSAI 2015 in Reykjavik.…”