Have changes in ventilation practice improved outcome in children with acute lung injury?
OBJECTIVE
To describe the changes that have occurred in mechanical ventilation in children with acute lung injury in our institution over the last 10-15 yrs and to examine the impact of these changes, in particular of the delivered tidal volume on mortality.


METHODS
Retrospective study.


METHODS
University-affiliated children's hospital.


METHODS
The management of mechanical ventilation between 1988 and 1992 (past group, n = 79) was compared with the management between 2000 and 2004 (recent group, n = 85).


METHODS
None.


RESULTS
The past group patients were ventilated with a significantly higher mean tidal volume (10.2 +/- 1.7 vs. 8.1 +/- 1.4 mL.kg actual body weight, p < .001), lower levels of positive end-expiratory pressure (6.1 +/- 2.7 vs. 7.1 +/- 2.4 cm H2O, p = .007), and higher mean peak inspiratory pressure (31.5 +/- 7.3 vs. 27.8 +/- 4.2 cm H2O, p < .001) than the recent group patients. The recent group had a lower mortality (21% vs. 35%, p = .04) and a greater number of ventilator-free days (16.0 +/- 9.0 vs. 12.6 +/- 9.9 days, p = .03) than the past group. A higher tidal volume was independently associated with increased mortality (odds ratio 1.59; 95% confidence interval 1.20, 2.10, p < .001) and reduction in ventilation-free days (95% confidence interval -1.24, -0.77, p < .001).


CONCLUSIONS
The changes in the clinical practice of mechanical ventilation in children in our institution reflect those reported for adults. In our experience, mortality among children with acute lung injury was reduced by 40%, and tidal volume was independently associated with reduced mortality and an increase in ventilation-free days.
Albuali
Waleed H
WH
Department of Pediatrics and Pediatric Critical Care Unit, Children's Hospital of Western Ontario, London Health Sciences Center, University of Western Ontario, London, ON, Canada.
Singh
Ram N
RN
Fraser
Douglas D
DD
Seabrook
Jamie A
JA
Kavanagh
Brian P
BP
Parshuram
Christopher S
CS
Kornecki
Alik
A
D000293:Adolescent; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013990:Tidal Volume
D001993:Bronchodilator Agents; D009569:Nitric Oxide