Journal:Journal of the American College of Surgeons
Year, Volume, Issue, Page(s):15, 220, 4, 570-578
Study examined the effects of low and high tidal volume ventilation on the number of ventilator days, ventilation pressures, and incidence of atelectasis, pneumonia, and acute respiratory distress syndrome (ARDS) in pediatric burned patients with inhalation injury. Inhalation injury was diagnosed by bronchoscopy in 932 pediatric burned patients who were admitted to the Shriners Hospital for Children-Galveston from 1986 to 2014. Patients were divided into 3 groups: 241 patients who did not receive any type of ventilation, 190 patients who received high tidal volume (HTV) ventilation of 15 milliliters per kilogram (mL/kg) of body mass, and 501 patients who received low tidal volume (LTV) ventilation of 9 mL/kg. Results showed that HTV was associated with significantly decreased ventilator days and maximum positive end expiratory pressure and significantly increased maximum peak inspiratory pressure and plateau pressure compared with those in patients with LTV. The incidence of atelectasis and ARDS 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. Findings suggest that HTV significantly decreases ventilator days and the incidence of both atelectasis and ARDS compared with LTV in pediatric burned patients with inhalation injury. Future studies should explore the differences in lung compliance and resistance, as well as work of breathing and blood flow, between high and low tidal volume use.