Mechanical Ventilation of the Children

Park, June Dong

Abstract

Mechanical ventilation in children has some differences compared to in neonates or in adults. The indication of mechanical ventilation can be classified into two groups, hypercapnic respiratory failure and hypoxemic respiratory failure. The strategies of mechanical ventilation should be different in these two groups. In hypercapnic respiratory failure, volume target ventilation with constant flow is favorable and pressure target ventilation with constant pressure is preferred in hypoxemic respiratory failure. For oxygenation, fraction of inspired oxygen (FiO2) and mean airway pressure (MAP) can be adjusted. MAP is more important than FiO2. Positive end expiratory pressure (PEEP) is the most potent determinant of MAP. The optimal relationship of FiO2 and PEEP is PEEP = FiO2 x 20. For ventilation, minute volume of ventilation (MV) product of tidal volume (TV) and ventilation frequency is the most important factor. TV has an maximum value up to 15 mL/kg to avoid the volutrauma, so ventilation frequency is more important. The time constant (TC) in children is usually 0.15-0.2. Adequate inspiratory time is 3TC, and expiratory time should be more than 5TC. In some severe respiratory failure, to get 8TC for one cycle is impossible because of higher frequency. In such case, permissive hypercapnia can be considered. The strategy of mechanical ventilation should be adjusted gradually even in the same patient according to the status of the patient. Mechanical ventilators and ventilation modes are progressing with advances in engineering. But the most important thing in mechanical ventilation is profound understanding about the basic pulmonary mechanics and classic ventilation modes.