Mechanical Ventilation of Pediatric Patients in the Emergency Department

Points & Pearls Excerpt

• Pediatric patients have higher resistance due to narrower airways, as well as high chest-wall compliance. A more pliable chest wall results in lower functional residual capacity.
• Use a cuffed endotracheal tube in all children.
• Clinicians should use the mode of ventilation that is most familiar to them; the choice should be based on clinician experience, patient pathophysiology, and ventilator availability.
• Use synchronized intermittent mandatory ventilation (SIMV) for patients without spontaneous respiratory effort, and use SIMV with pressure support for patients with spontaneous respiratory effort.
• Use assist-control ventilation in patients with little to no spontaneous respiratory effort or in those who require complete respiratory support, as the ventilator will assume full work of breathing

Most Important References

• Pacheco GS, Mendelson J, Gaspers M. Pediatric ventilator management in the emergency department. Emerg Med Clin North Am. 2018;36(2):401-413. (Review) 
• Duyndam A, Ista E, Houmes RJ, et al. Invasive ventilation modes in children: a systematic review and meta-analysis. Crit Care. 2011;15(1):R24. (Systematic review and meta-analysis; 5 trials, 421 patients) 
• Kneyber MCJ, de Luca D, Calderini E, et al. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med. 2017;43(12):1764-1780. (Guideline recommendations) 
• Rimensberger PC, Cheifetz IM, Pediatric Acute Lung Injury Consensus Conference Group. Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5 Suppl 1):S51-S60. (Guideline recommendations) 
• Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-439. (Consensus recommendations)