Respiratory systemInsights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaningTurner, David A; Arnold, John HAuthor Information Harvard Medical School and Department of Anesthesia, Division of Critical Care Medicine, Children's Hospital, Boston, Massachusetts, USA Correspondence to David A. Turner, MD, 300 Longwood Ave. Farley 517, Boston, MA 02115, USA Tel: +1 617 355 7327; fax: +1 617 734 3863; e-mail: [email protected] Current Opinion in Critical Care: February 2007 - Volume 13 - Issue 1 - p 57-63 doi: 10.1097/MCC.0b013e32801297f9 Buy Metrics Abstract Purpose of review Mechanical ventilation is a common intervention provided by pediatric intensivists. This fact notwithstanding, the management of mechanical ventilation in pediatrics is largely guided by a few pediatric trials along with careful interpretation and application of adult data. Recent findings A low tidal volume, pressure limited approach to mechanical ventilation as established by the Acute Respiratory Distress Syndrome Network investigators, has become the prevailing practice in pediatric intensive care. Studies by these investigators suggest that high positive end expiratory pressure and recruitment maneuvers are not uniformly beneficial. High frequency oscillatory ventilation continues to be evaluated in an attempt to provide ‘open lung’ ventilation. Airway pressure release ventilation is a newer mode of ventilation that may combine the ‘open lung’ approach with spontaneous breathing. Prone positioning was demonstrated in a recent pediatric trial to have no effect on outcome, while calfactant was found to potentially improve outcomes in pediatric acute respiratory distress syndrome. Ventilator weaning protocols may not be as useful in pediatrics as in adults. Systemic corticosteroids decrease the incidence of post extubation stridor and may reduce reintubation rates. Summary Mechanical ventilation with pressure limitation and low tidal volumes has become customary in pediatric intensive care units, and this lung protective approach will continue into the foreseeable future. Further investigation is warranted regarding use of high frequency oscillatory ventilation, airway pressure release ventilation, and surfactant to assist pediatric intensivists in application of these therapies. © 2007 Lippincott Williams & Wilkins, Inc.