Effect of tidal volume in children with acute hypoxemic respiratory failure

Intensive Care Med. 2009 Aug;35(8):1428-37. doi: 10.1007/s00134-009-1527-z. Epub 2009 Jun 17.


Objectives: To determine if tidal volume (VT) between 6 and 10 ml/kg body weight using pressure control ventilation affects outcome for children with acute hypoxemic respiratory failure (AHRF) or acute lung injury (ALI). To validate lung injury severity markers such as oxygenation index (OI), PaO2/FiO2 (PF) ratio, and lung injury score (LIS).

Design: Retrospective, January 2000-July 2007.

Setting: Tertiary care, 20-bed PICU.

Patients: Three hundred and ninety-eight endotracheally intubated and mechanically ventilated children with PF ratio <300. Outcomes were mortality and 28-day ventilator free days.

Measurements and main results: Three hundred and ninety-eight children met study criteria, with 20% mortality. 192 children had ALI. Using >90% pressure control ventilation, 85% of patients achieved VT less than 10 ml/kg. Median VT was not significantly different between survivors and non-survivors during the first 3 days of mechanical ventilation. After controlling for diagnostic category, age, delta P (PIP-PEEP), PEEP, and severity of lung disease, VT was not associated with mortality (P > 0.1), but higher VT at baseline and on day 1 of mechanical ventilation was associated with more ventilator free days (P < 0.05). This was particularly seen in patients with better respiratory system compliance [Crs > 0.5 ml/cmH2O/kg, OR = 0.70 (0.52, 0.95)]. OI, PF ratio, and LIS were all associated with mortality (P < 0.05).

Conclusions: When ventilating children using lung protective strategies with pressure control ventilation, observed VT is between 6 and 10 ml/kg and is not associated with increased mortality. Moreover, higher VT within this range is associated with more ventilator free days, particularly for patients with less severe disease.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Lung Injury / physiopathology
  • Child, Preschool
  • Female
  • Humans
  • Hypoxia / physiopathology*
  • Lung Volume Measurements / methods
  • Male
  • Positive-Pressure Respiration
  • Respiratory Insufficiency / mortality
  • Respiratory Insufficiency / physiopathology*
  • Retrospective Studies
  • Tidal Volume / physiology*