Paediatric mechanical ventilation in the intensive care unit

Abstract

### Key points The care of the ventilated paediatric patient requires an extensive understanding of respiratory mechanics and pathophysiology of cardiopulmonary disease. Many of the fundamental principles of respiratory physiology and gas exchange are similar to those of adults and will not be the focus of discussion. Instead, our aim is to review features of mechanical ventilation that are distinctive to the paediatric population. Ventilation of premature infants is a unique subset of paediatric ventilation and will not be addressed in this article. As the adage says, ‘children are not small adults’, and management of ventilated paediatric patients requires an appreciation of the susceptibility of developing lung tissue to injury, congenital anomalies, disease processes specific to the paediatric population, and the potential equipment-related difficulties associated with small patients. Considered together, each paediatric patient who requires mechanical ventilation represents a unique clinical problem. While the majority of tracheal tubes (TTs) placed in critically ill children are for the purposes of facilitating mechanical ventilation, decisions at the time of airway placement may have important implications. Features specific to paediatric patients (e.g. size, anatomy, inability to follow instructions) leave them at particular risk for compromising their airway security. ### Tracheal tube type and route Uncuffed TTs have traditionally been used in children due to historic anatomical surveys revealing the …