| Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. | |
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MedLine Citation:
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PMID: 20228688 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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OBJECTIVES: To describe mechanical ventilation strategies in acute lung injury and to estimate the number of eligible patients for clinical trials on mechanical ventilation management. In contrast to adult medicine, there are few clinical trials to guide mechanical ventilation management in children with acute lung injury. DESIGN: A cross-sectional study for six 24-hr periods from June to November 2007. SETTING: Fifty-nine pediatric intensive care units in 12 countries in North America and Europe. PATIENTS: We identified children meeting acute lung injury criteria and collected detailed information on illness severity, mechanical ventilatory support, and use of adjunctive therapies. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 3823 patients screened, 414 (10.8%) were diagnosed with acute lung injury by their treating physician, but only 165 (4.3%) patients met prestablished inclusion/exclusion criteria to this trial and, therefore, would have been eligible for a clinical trial. Of these, 124 (75.2%) received conventional mechanical ventilation, 27 (16.4%) received high-frequency oscillatory ventilation, and 14 (8.5%) received noninvasive mechanical ventilation. In the conventional mechanical ventilation group, 43.5% were ventilated in a pressure control mode with a mean tidal volume of 8.3 ± 3.3 mL/kg; and there was no clear relationship between positive end-expiratory pressure and Fio2 delivery in the conventional mechanical ventilation group. Use of adjunctive treatments, including nitric oxide, prone positioning, surfactant, hemofiltration, recruitment maneuvers, steroids, bronchodilators, and fluid restriction, was highly variable. CONCLUSIONS: Our study reveals inconsistent mechanical ventilation practice and use of adjunctive therapies in children with acute lung injury. Pediatric clinical trials assessing mechanical ventilation management are needed to generate evidence to optimize outcomes. We estimate that a large number of centers (∼60) are needed to conduct such trials; it is imperative, therefore, to bring about international collaboration. |
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Authors:
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Miriam Santschi; Philippe Jouvet; Francis Leclerc; France Gauvin; Christopher J L Newth; Christopher L Carroll; Heidi Flori; Robert C Tasker; Peter C Rimensberger; Adrienne G Randolph; ; ; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Volume: 11 ISSN: 1529-7535 ISO Abbreviation: Pediatr Crit Care Med Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-08 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100954653 Medline TA: Pediatr Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 681-9 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada. Miriam.Santschi@USherbrooke.ca |
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Comment In:
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Pediatr Crit Care Med. 2010 Nov;11(6):751-2
[PMID:
21057265
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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