title: Conventional mechanical ventilation in pediatrics.
abstract: OBJECTIVE
  To review the various challenges of providing mechanical ventilation to pediatric patients with diseases of increased airway resistance, diseases of abnormal lung compliance or normal lungs.
  
  
  METHODS
  Original data from our pediatric intensive care unit and animal research laboratory. Relevant articles included in the MEDLINE electronic database during the last 10 years. Also included were book chapters and definitive studies, as judged by the authors, in the fields of asthma, acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury and permissive hypercapnia.
  
  
  RESULTS
  Mechanical ventilation of patients with diseases of increased airway resistance should center on avoidance of dynamic hyperinflation, allowing complete exhalation prior to the initiation of a subsequent breath and permissive hypercapnia. Positive end-expiratory pressure should be used sparingly to prevent atelectasis and facilitate synchrony in spontaneously breathing patients. Mechanical ventilation of patients with diseases of abnormal lung compliance should take into consideration the inhomogeneous distribution of lung disease. Focus should be on avoidance of volutrauma and atelectrauma that could result in ventilator-associated lung injury.
  
  
  CONCLUSIONS
  The last decade was marked by significant advances in the management of pediatric respiratory failure. The choice of mechanical ventilation strategy can significantly influence the subsequent course of lung injury. Mechanical ventilation can no longer be viewed simply as a harmless support modality that is employed to keep patients alive while disease-specific treatments are used to ameliorate the underlying pathology.
authors.affiliation: University of Texas Medical Branch at Galveston, Galveston, TX, USA. alexrotta@stx.rr.com
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Rotta
authors.forename: David M
authors.initials: DM
authors.lastname: Steinhorn
mesh_terms: D000403:Airway Resistance; D001249:Asthma / Q000628:therapy; D001469:Barotrauma; D002648:Child; D006612:High-Frequency Ventilation; D006801:Humans; D006935:Hypercapnia / Q000209:etiology* / Q000517:prevention & control; D055370:Lung Injury; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012122:Ventilators, Mechanical