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Tidal Volume and Mortality in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis of Observational Studies*

de Jager, Pauline MD1; Burgerhof, Johannes G. M. MSc2; van Heerde, Marc MD, PhD3; Albers, Marcel J. I. J. MD, PhD4; Markhorst, Dick G. MD, PhD3; Kneyber, Martin C. J. MD, PhD1,3,5

doi: 10.1097/CCM.0000000000000546
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Objective: To determine whether tidal volume is associated with mortality in critically ill, mechanically ventilated children.

Data Sources: MEDLINE, EMBASE, and CINAHL databases from inception until July 2013 and bibliographies of included studies without language restrictions.

Study Selection: Randomized clinical trials and observational studies reporting mortality in mechanically ventilated PICU patients.

Data Extraction: Two authors independently selected studies and extracted data on study methodology, quality, and patient outcomes. Meta-analyses were performed using the Mantel-Haenszel random-effects model. Heterogeneity was quantified using I2. Study quality was assessed using the Newcastle-Ottawa Score for cohort studies.

Data Synthesis: Out of 142 citations, seven studies met the inclusion criteria, and additional two articles were identified from references of the found articles. One was excluded. These eight studies included 1,756 patients. Mortality rates ranged from 13% to 42%. There was no association between tidal volume and mortality when tidal volume was dichotomized at 7, 8, 10, or 12 mL/kg. Comparing patients ventilated with tidal volume less than 7 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg and tidal volume less than 8 mL/kg and greater than 10 mL/kg or greater than 12 mL/kg also showed no association between tidal volume and mortality. Limiting the analysis to patients with acute lung injury/acute respiratory distress syndrome did not change these results. Heterogeneity was observed in all pooled analyses.

Conclusions: A relationship between tidal volume and mortality in mechanically ventilated children could not be identified, irrespective of the severity of disease. The significant heterogeneity observed in the pooled analyses necessitates future studies in well-defined patient populations to understand the effects of tidal volume on patient outcome.

1Division of Paediatric Intensive Care, Department of Paediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands.

2Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands.

3Department of Paediatric Intensive Care, VU University Medical Center, Amsterdam, The Netherlands.

4St. Elisabeth Hospital, Tilburg, The Netherlands.

5Critical Care, Anaesthesiology, Peri-operative Medicine and Emergency Medicine, the University of Groningen, Groningen, The Netherlands.

* See also p. 2625.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: m.c.j.kneyber@umcg.nl

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins