Ventilatory support in children with pediatric acute respiratory distress syndrome: Proceedings from the pediatric acute lung injury consensus conference

for the Pediatric Acute Lung Injury Consensus Conference Group

Research output: Contribution to journalArticle

Abstract

Objective: To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome. Design: Consensus Conference of experts in pediatric acute lung injury. Methods: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome. Topics included ventilator mode, tidal volume delivery, inspiratory plateau pressure, high-frequency ventilation, cuffed endotracheal tubes, and gas exchange goals. When experimental data were lacking, a modified Delphi approach emphasizing the strong professional agreement was used. Results: There were 17 recommendations with strong agreement and 10 recommendations with weak agreement. There were no recommendations with equipoise or disagreement. There was weak agreement on recommendations concerning approach to tidal volume and inspiratory pressure limitation (88% to 72% agreement, respectively), whereas strong agreement could be achieved for accepting permissive hypercapnia. Using positive end-expiratory pressure levels greater than 15 cm H2O in severe pediatric acute respiratory distress syndrome, under the condition that the markers of oxygen delivery, respiratory system compliance, and hemodynamics are closely monitored as positive end-expiratory pressure is increased, is strongly recommended. The concept of exploring the effects of careful recruitment maneuvers during conventional ventilation met an agreement level of 88%, whereas the use of recruitment maneuvers during rescue high- frequency oscillatory ventilation is highly recommended (strong agreement). Conclusions: The Consensus Conference developed pediatricspecific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation. (Pediatr Crit Care Med 2015; 16:S51-S60).

Original languageEnglish (US)
Pages (from-to)S51-S60
JournalPediatric Critical Care Medicine
Volume16
Issue number5
DOIs
StatePublished - Jun 1 2015

Fingerprint

Acute Lung Injury
Adult Respiratory Distress Syndrome
Pediatrics
Artificial Respiration
High-Frequency Ventilation
Positive-Pressure Respiration
Tidal Volume
Pressure
Hypercapnia
Mechanical Ventilators
Respiratory System
Compliance
Ventilation
Gases
Hemodynamics
Oxygen
Research

Keywords

  • Lung injury
  • Mechanical ventilation
  • Pediatric acute respiratory distress syndrome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Ventilatory support in children with pediatric acute respiratory distress syndrome : Proceedings from the pediatric acute lung injury consensus conference. / for the Pediatric Acute Lung Injury Consensus Conference Group.

In: Pediatric Critical Care Medicine, Vol. 16, No. 5, 01.06.2015, p. S51-S60.

Research output: Contribution to journalArticle

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title = "Ventilatory support in children with pediatric acute respiratory distress syndrome: Proceedings from the pediatric acute lung injury consensus conference",
abstract = "Objective: To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome. Design: Consensus Conference of experts in pediatric acute lung injury. Methods: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome. Topics included ventilator mode, tidal volume delivery, inspiratory plateau pressure, high-frequency ventilation, cuffed endotracheal tubes, and gas exchange goals. When experimental data were lacking, a modified Delphi approach emphasizing the strong professional agreement was used. Results: There were 17 recommendations with strong agreement and 10 recommendations with weak agreement. There were no recommendations with equipoise or disagreement. There was weak agreement on recommendations concerning approach to tidal volume and inspiratory pressure limitation (88{\%} to 72{\%} agreement, respectively), whereas strong agreement could be achieved for accepting permissive hypercapnia. Using positive end-expiratory pressure levels greater than 15 cm H2O in severe pediatric acute respiratory distress syndrome, under the condition that the markers of oxygen delivery, respiratory system compliance, and hemodynamics are closely monitored as positive end-expiratory pressure is increased, is strongly recommended. The concept of exploring the effects of careful recruitment maneuvers during conventional ventilation met an agreement level of 88{\%}, whereas the use of recruitment maneuvers during rescue high- frequency oscillatory ventilation is highly recommended (strong agreement). Conclusions: The Consensus Conference developed pediatricspecific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation. (Pediatr Crit Care Med 2015; 16:S51-S60).",
keywords = "Lung injury, Mechanical ventilation, Pediatric acute respiratory distress syndrome",
author = "{for the Pediatric Acute Lung Injury Consensus Conference Group} and Rimensberger, {Peter C.} and Cheifetz, {Ira M.} and Philippe Jouvet and Thomas, {Neal J.} and Willson, {Douglas F.} and Simon Erickson and Robinder Khemani and Lincoln Smith and Jerry Zimmerman and Mary Dahmer and Heidi Flori and Michael Quasney and Anil Sapru and Martin Kneyber and Tamburro, {Robert F.} and Curley, {Martha A Q} and Vinay Nadkarni and Stacey Valentine and Guillaume Emeriaud and Christopher Newth and Carroll, {Christopher L.} and Sandrine Essouri and Heidi Dalton and Duncan Macrae and Yolanda Lopez and Miriam Santschi and Watson, {R. Scott} and Melania Bembea",
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AU - for the Pediatric Acute Lung Injury Consensus Conference Group

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AU - Cheifetz, Ira M.

AU - Jouvet, Philippe

AU - Thomas, Neal J.

AU - Willson, Douglas F.

AU - Erickson, Simon

AU - Khemani, Robinder

AU - Smith, Lincoln

AU - Zimmerman, Jerry

AU - Dahmer, Mary

AU - Flori, Heidi

AU - Quasney, Michael

AU - Sapru, Anil

AU - Kneyber, Martin

AU - Tamburro, Robert F.

AU - Curley, Martha A Q

AU - Nadkarni, Vinay

AU - Valentine, Stacey

AU - Emeriaud, Guillaume

AU - Newth, Christopher

AU - Carroll, Christopher L.

AU - Essouri, Sandrine

AU - Dalton, Heidi

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N2 - Objective: To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome. Design: Consensus Conference of experts in pediatric acute lung injury. Methods: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome. Topics included ventilator mode, tidal volume delivery, inspiratory plateau pressure, high-frequency ventilation, cuffed endotracheal tubes, and gas exchange goals. When experimental data were lacking, a modified Delphi approach emphasizing the strong professional agreement was used. Results: There were 17 recommendations with strong agreement and 10 recommendations with weak agreement. There were no recommendations with equipoise or disagreement. There was weak agreement on recommendations concerning approach to tidal volume and inspiratory pressure limitation (88% to 72% agreement, respectively), whereas strong agreement could be achieved for accepting permissive hypercapnia. Using positive end-expiratory pressure levels greater than 15 cm H2O in severe pediatric acute respiratory distress syndrome, under the condition that the markers of oxygen delivery, respiratory system compliance, and hemodynamics are closely monitored as positive end-expiratory pressure is increased, is strongly recommended. The concept of exploring the effects of careful recruitment maneuvers during conventional ventilation met an agreement level of 88%, whereas the use of recruitment maneuvers during rescue high- frequency oscillatory ventilation is highly recommended (strong agreement). Conclusions: The Consensus Conference developed pediatricspecific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation. (Pediatr Crit Care Med 2015; 16:S51-S60).

AB - Objective: To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome. Design: Consensus Conference of experts in pediatric acute lung injury. Methods: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome. Topics included ventilator mode, tidal volume delivery, inspiratory plateau pressure, high-frequency ventilation, cuffed endotracheal tubes, and gas exchange goals. When experimental data were lacking, a modified Delphi approach emphasizing the strong professional agreement was used. Results: There were 17 recommendations with strong agreement and 10 recommendations with weak agreement. There were no recommendations with equipoise or disagreement. There was weak agreement on recommendations concerning approach to tidal volume and inspiratory pressure limitation (88% to 72% agreement, respectively), whereas strong agreement could be achieved for accepting permissive hypercapnia. Using positive end-expiratory pressure levels greater than 15 cm H2O in severe pediatric acute respiratory distress syndrome, under the condition that the markers of oxygen delivery, respiratory system compliance, and hemodynamics are closely monitored as positive end-expiratory pressure is increased, is strongly recommended. The concept of exploring the effects of careful recruitment maneuvers during conventional ventilation met an agreement level of 88%, whereas the use of recruitment maneuvers during rescue high- frequency oscillatory ventilation is highly recommended (strong agreement). Conclusions: The Consensus Conference developed pediatricspecific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation. (Pediatr Crit Care Med 2015; 16:S51-S60).

KW - Lung injury

KW - Mechanical ventilation

KW - Pediatric acute respiratory distress syndrome

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