Is a Lung Protective Strategy Routinely Used for Pediatric Patients in the ICU?

Abstract

Background:

Tidal volume (V_T) selection for pediatric patients undergoing mechanical ventilation continues to be a controversial issue. While ideal body weight (IBW) has been recommended to select V_T, actual body weight (ABW) is often used. The purpose of this study was to determine if tidal volume selection was based on IBW or ABW, and if selection was based on using a lung protective strategy.

Methods:

Retrospective chart review of patients < 18 y of age, admitted to a pediatric ICU in an academic-affiliated institution. Subjects receiving mechanical ventilation during general anesthesia for surgery or anticipated mechanical ventilation to be < 48 h were excluded. Demographic information, vital signs, arterial blood gases, and ventilator parameters upon admission to ICU (FIO₂, V_T, PEEP) were collected. Lung protective strategy, in regard to V_T selection, was defined as 6-8 mL/kg.

Results:

Data was collected from 30 patients admitted to a PICU between Jan of 2017 and March of 2018. Mean age 7.3 y (± 5.8). SIMV VC was selected in 97% of the patients included for analysis. The mean V_T selected in this group of patients was 7.65 mL/kg (± 2.55; range: 2.78-12.08; IQR 5.3-8. 2) when ABW was used. Mean V_T in mL/kg (IBW) was 7.04 (± 2.36; range 4.0-18.37; IQR 6.5-8.2) ; P=0.24. Mean ventilator length of stay was 4.1 d (range: 0.13-25; IQR 0.9-5.7). PEEP level was 5.9 cm H₂O (± 1.7) and FIO₂ was 0.65 (± 0.26). On 21 patients, where ABG were available, the P/F ratio was 309.3 (± 188) and oxygen index 5.2 (± 5.7). When IBW was used, 26.6% of the patients where set on a V_T <6 mL/kg while in 30% V_T was set > 8 mL/kg.

Conclusions:

Most pediatric patients in the ICU receive a mean V_T between 6 and 8 mL/kg despite the weight scale selected. Although V_T selection in these pediatric patients was not significantly different if IBW or ABW is used, there is still a large percent of patients for whom V_T is selected outside the range considered as lung protective.