Abstract
Aim: #Patientcare protocols and mechanical #ventilatormodes
capable of auto-adjusting settings based on integrated, non invasive
monitoring techniques are being developed to improve the quality of
#paediatric mechanical ventilation. We performed a study to describe
which criteria intensivists currently use to make ventilator setting
changes.
Methods: Critically ill children admitted to the intensive
care units at Sainte-Justine Hospital (SJH) and the Children’s Hospital
Los Angeles
(CHLA) was included throughout all phases of invasive mechanical
ventilation. The reasons for ventilator setting modifications were
recorded
by caregivers in real time. Temporary modifications made during
suctioning or subject manipulations were excluded.
Results: Twenty subjects were included at Sainte-Justine
Hospital and fifteen at the Children’s Hospital Los Angeles. The mean
duration
of electronic capture of ventilator setting modifications was around 6
days in both centers. Excluding changes to FiO2, the median number of
setting changes per subject per day was 2.5 at HSJ and 0.9 at CHLA. PaCO2 was identified as the main primary reason for #respiratoryrate, tidal
volume or positive #aspiratorypressure changes at SJH and pH was the main primary reason at CHLA. EtCO2
was not used frequently as the
primary reason for adjustments in both hospitals. Pulse oximetry was
also identified as the main primary reason for 34.1% at SJH and 25% at
CHLA of changes to PEEP. Except for FiO2, less than the half of the changes of ventilator settings were based on elements which were potentially
in corpora table into automatic protocols.
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