The top ten unknowns in paediatric mechanical ventilation

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1、IntensiveCareMedDOI10.1007/s00134-017-4847-4WHAT’SNEWININTENSIVECAREThetoptenunknownsin paediatricmechanicalventilationPeterC.Rimensberger1*,IraM.Cheifetz2andMartinC.J.Kneyber3,4©2017Springer-VerlagBerlinHeidelbergandESICMIntroductionscoresandmortalitypredicti

2、onscores,seemstobemorehereisinconsistentmechanicalventilation(MV)prac-sensitiveinpredictingoutcome(i.e.ICUmortality)thanticeinchildren[1]giventhefactthateventodayitisanyventilatorstrategythattargetsanyspeciicVt[6].largelybasedonexpertopinionanddataextrapolatio

3、nWhetherthiscanbeconirmedwhenapplyingnewerfromadultsdespitethepaediatriccatchphrase“achildconceptsofprotectiveventilation(e.g.limitationofdriv-isnotjustasmalladult”.Uniquematurationaldifer-ingpressure)remainsunclear.encesrelatedtolunggrowthandmaturation(tothea

4、geFurthermore,long-termneurodevelopmentaloutcomeofabout8 years),respiratorysystemdevelopment(e.g.remainslargelyunknown.smallairways,compliantchestwall),immuneresponseandsurfactanthomeostasispreventdatageneratedin2.Positiveend-expiratorypressure(PEEP)andlungadu

5、ltsbeingdirectlyapplicabletochildren.Moreover,arecruitmentstrategiespossibleage-relatedsusceptibilitytoventilator-inducedlunginjuryhasbeensuggested[2].Furthermore,thereAlthoughcharacteristicsoftherespiratorysystemoftheisamuchlargerspectrumofpathologiesassociat

6、edwithsmallchildwithacutehypoxicrespiratoryfailure(i.e.lowhypoxemicand/orhypercapnicrespiratoryfailureinchestwallelastance,lowfunctionalresidualcapacity)infantsandchildrenthaninadults.wouldcallforPEEPtitrationforimprovingoxygenationGiventhiscontext,weidentiied

7、10majorunknownsandcompliancewithaminimalriskforsideefects[7,8],regardingpaediatricMVinthefollowingcategories:(1)littleknowledgeonhowtoguidePEEPtitrationorotherlung“protective”ventilationstrategies,(2)conceptstorecruitmentmanoeuvresexists.assistspontaneousbreat

8、hing,(3)useofnon-invasivesupportand(4)weaningfromMV.3.HighfrequencyoscillationLung“protective”strategiesHighfrequencyoscillationventilation(HFOV)forpaedi-atricacuterespiratorydistr