*Corresponding author:Philippe Jouvet, Pediatric ICU, Sainte-Justine Hospital, Montreal, Canada
Received: February 17, 2018; Published: February 27, 2018
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Aim: Patient care protocols and mechanical ventilator modes capable of auto-adjusting settings based on integrated, non invasive monitoring techniques are being developed to improve the quality of paediatric mechanical ventilation. We performed a study to describe which criteria intensivists currently use to make ventilator setting changes.
Methods: Critically ill children admitted to the intensive care units at Sainte-Justine Hospital (SJH) and the Children’s Hospital Los Angeles (CHLA) was included throughout all phases of invasive mechanical ventilation. The reasons for ventilator setting modifications were recorded by caregivers in real time. Temporary modifications made during suctioning or subject manipulations were excluded.
Results: Twenty subjects were included at Sainte-Justine Hospital and fifteen at the Children’s Hospital Los Angeles. The mean duration of electronic capture of ventilator setting modifications was around 6 days in both centers. Excluding changes to FiO2, the median number of setting changes per subject per day was 2.5 at HSJ and 0.9 at CHLA. PaCO2 was identified as the main primary reason for respiratory rate, tidal volume or positive aspiratory pressure changes at SJH and pH was the main primary reason at CHLA. EtCO2 was not used frequently as the primary reason for adjustments in both hospitals. Pulse oximetry was also identified as the main primary reason for 34.1% at SJH and 25% at CHLA of changes to PEEP. Except for FiO2, less than the half of the changes of ventilator settings were based on elements which were potentially in corpora table into automatic protocols.
Conclusion: This study reveals that physician over-estimate the role of blood pH and PCO2 in their ventilation management strategies. Furthermore, roughly half the changes to PEEP, 40% of the changes to respiratory rate, tidal volume or positive aspiratory pressure could potentially be managed by automatic ventilator modes based on technology which already exists.
Keywords: Mechanical Ventilation; Automated Ventilation; Paediatric Intensive Care
Abbreviations: CHLA: Children’s Hospital Los Angeles; SJH: Sainte-Justine Hospital; IRB: Institutional Review Board; PICU: Pediatric Intensive Care Units; PIP:Positive Aspiratory Pressure; PS: Pressure Support; PEEP: Positive End-Expiratory Pressure