High tidal volume decreases adult respiratory distress syndrome, atelectasis, and ventilator days compared with low tidal volume in pediatric burned patients with inhalation injury.
BACKGROUND
Inhalation injury, which is among the causes of acute lung injury and acute respiratory distress syndrome (ARDS), continues to represent a significant source of mortality in burned patients. Inhalation injury often requires mechanical ventilation, but the ideal tidal volume strategy is not clearly defined in burned pediatric patients. The aim of this study was to determine the effects of low and high tidal volume on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and ARDS in pediatric burned patients with inhalation injury within 1 year post burn injury.


METHODS
From 1986 to 2014, inhalation injury was diagnosed by bronchoscopy in pediatric burned patients (n = 932). Patients were divided into 3 groups: unventilated (n = 241), high tidal volume (HTV, 15 ± 3 mL/kg, n = 190), and low tidal volume (LTV, 9 ± 3 mL/kg, n = 501).


RESULTS
High tidal volume was associated with significantly decreased ventilator days (p < 0.005) and maximum positive end expiratory pressure (p < 0.0001) and significantly increased maximum peak inspiratory pressure (p < 0.02) and plateau pressure (p < 0.02) compared with those in patients with LTV. The incidence of atelectasis (p < 0.0001) and ARDS (p < 0.02) was significantly decreased with HTV compared with LTV. However, the incidence of pneumothorax was significantly increased in the HTV group compared with the LTV group (p < 0.03).


CONCLUSIONS
High tidal volume significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared with low tidal volume in pediatric burned patients with inhalation injury. Therefore, the use of HTV may interrupt sequences leading to lung injury in our patient population.
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Burn Unit, Galveston, TX.
Linda E
LE
Sousse
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Burn Unit, Galveston, TX.
David N
DN
Herndon
Department of Surgery, University of Texas Medical Branch, Galveston, TX.
Clark R
CR
Andersen
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Burn Unit, Galveston, TX.
Arham
A
Ali
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Burn Unit, Galveston, TX.
Nicole C
NC
Benjamin
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Burn Unit, Galveston, TX.
Thomas
T
Granchi
Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Burn Unit, Galveston, TX.
Oscar E
OE
Suman
Shriners Hospitals for Children, Burn Unit, Galveston, TX. Electronic address: rmlcak@utmb.edu.
Ronald P
RP
Mlcak
D000293:Adolescent; D002059:Burns, Inhalation / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D013990:Tidal Volume / Q000502:physiology*; D016896:Treatment Outcome