Abstract
IntroductionThe purpose of the present study was to critically review the existing body of evidence on ventilation modes for infants and children up to the age of 18 years.MethodsThe PubMed and EMBASE databases were searched using the search terms 'artificial respiration', 'instrumentation', 'device', 'devices', 'mode', and 'modes'. The review included only studies comparing two ventilation modes in a randomized controlled study and reporting one of the following outcome measures: length of ventilation (LOV), oxygenation, mortality, chronic lung disease and weaning. We quantitatively pooled the results of trials where suitable.ResultsFive trials met the inclusion criteria. They addressed six different ventilation modes in 421 children: high-frequency oscillation (HFO), pressure control (PC), pressure support (PS), volume support (VS), volume diffusive respirator (VDR) and biphasic positive airway pressure. Overall there were no significant differences in LOV and mortality or survival rate associated with the different ventilation modes. Two trials compared HFO versus conventional ventilation. In the pooled analysis, the mortality rate did not differ between these modes (odds ratio = 0.83, 95% confidence interval = 0.30 to 1.91). High-frequency ventilation (HFO and VDR) was associated with a better oxygenation after 72 hours than was conventional ventilation. One study found a significantly higher PaO2/FiO2 ratio with the use of VDR versus PC ventilation in children with burns. Weaning was studied in 182 children assigned to either a PS protocol, a VS protocol or no protocol. Most children could be weaned within 2 days and the weaning time did not significantly differ between the groups.ConclusionsThe literature provides scarce data for the best ventilation mode in critically ill children beyond the newborn period. There is no evidence, however, that high-frequency ventilation reduced mortality and LOV. Longer-term outcome measures such as pulmonary function, neurocognitive development, and cost-effectiveness should be considered in future studies.
Highlights
The purpose of the present study was to critically review the existing body of evidence on ventilation modes for infants and children up to the age of 18 years
For the two ventilation groups without inhaled nitric oxide (iNO), the length of ventilation (LOV) significantly differed between conventional ventilation (CV) and high-frequency oscillation (HFO) (WMD = -30.0 days, 95% confidence interval (CI) = -45.89 to -14.11)
The present review aimed at identifying the various ventilation modes used in children over the past three decades, searching for any data that would favor a particular mode for pediatric ventilation
Summary
The purpose of the present study was to critically review the existing body of evidence on ventilation modes for infants and children up to the age of 18 years. Ventilator-induced lung injury in critically ill children suffering from acute respiratory failure should be counteracted by adapting ventilation management to the cause of respiratory failure [1]. Bronchiolitis was the most frequent cause of respiratory failure in infants (43.6%); pneumonia the most frequent cause in older children (24.8%) [2]. The ventilation mode is often not targeted to the underlying disease but rather is determined by the intensive care physician’s experience, local pediatric intensive care unit policy and protocols, or outcomes of studies in adults [1,2,5]. An unambiguous international guideline is still lacking [1,5]
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