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Questions and Answers
What is the recommended range for tidal volume in pediatric patients with good lung compliance according to PALICC guidelines?
What is the recommended range for tidal volume in pediatric patients with good lung compliance according to PALICC guidelines?
5-8 mL/kg
What is the recommended range for tidal volume in pediatric patients with poor lung compliance according to PALICC guidelines?
What is the recommended range for tidal volume in pediatric patients with poor lung compliance according to PALICC guidelines?
3-6 mL/kg
What is the association between higher tidal volume and mortality in pediatric ARDS patients?
What is the association between higher tidal volume and mortality in pediatric ARDS patients?
Higher tidal volume is associated with higher mortality.
What is the association between lower tidal volume and mortality in pediatric ARDS patients?
What is the association between lower tidal volume and mortality in pediatric ARDS patients?
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What is the recommended range for moderately elevated levels of PEEP in pediatric ARDS patients?
What is the recommended range for moderately elevated levels of PEEP in pediatric ARDS patients?
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What is the indication for intubation and invasive ventilation in pediatric ARDS patients?
What is the indication for intubation and invasive ventilation in pediatric ARDS patients?
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What is the effect of NPPV on endotracheal intubation frequency in pediatric PARDS patients according to a randomized controlled trial?
What is the effect of NPPV on endotracheal intubation frequency in pediatric PARDS patients according to a randomized controlled trial?
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Study Notes
Lung-Protective Ventilation and Non-Invasive Positive Pressure Ventilation in Pediatric Acute Respiratory Distress Syndrome (PARDS)
- Non-invasive positive pressure ventilation (NPPV) can be considered in children with mild PARDS, as it can improve airway opening, alveolar recruitment, and oxygenation.
- A randomized controlled trial with 50 patients showed that NPPV significantly lowered the frequency of endotracheal intubation in PARDS patients.
- However, NPPV is not recommended for patients with severe hypoxemia.
- Intubation and invasive ventilation is indicated when there are signs of increased respiratory effort, decreased PaO2/FiO2 ratio, or altered levels of consciousness.
- Lung-protective ventilation strategies aim to avoid volutrauma and minimize atelectrauma.
- Optimal tidal volume in PARDS patients remains controversial and is usually based on data extrapolated from adult patients.
- A higher tidal volume is associated with higher mortality and shorter ventilation-free days, while a lower tidal volume is associated with reduced mortality and an increase in ventilation-free days.
- A high maximum and median tidal volume is associated with lower mortality, but a 2014 meta-analysis showed no significant association between tidal volume and mortality.
- PALICC recommends patient-specific tidal volume based on lung compliance, with a physiological range of 5-8 mL/kg for good lung compliance and 3-6 mL/kg for poor lung compliance.
- Adequate PEEP is necessary to prevent atelectrauma in patients with PARDS, and moderately elevated levels of PEEP (10-15 cm H2O) are recommended for titration of oxygenation and hemodynamic response.
- A PEEP level greater than 15 cm H2O might be required for severe PARDS.
- Children managed with PEEP lower than recommended by the ARDSNet PEEP/FiO2 model had a higher mortality, according to a retrospective analysis of PARDS patients.
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Description
Test your knowledge on lung-protective ventilation and non-invasive positive pressure ventilation in pediatric acute respiratory distress syndrome (PARDS) with this informative quiz. Learn about the benefits and limitations of NPPV, as well as the optimal tidal volume and PEEP levels for PARDS patients. Explore key recommendations from the PALICC guidelines and the ARDSNet PEEP/FiO2 model. Challenge yourself with important concepts and evidence-based practices in the field of pediatric respiratory support.
