Since the landmark articles by the ARDS Network in 1998 and 2000, low tidal volume (Vt) ventilation in critically ill adults has become a standard intervention to prevent ventilator-induced lung injury. However, despite the lack of confirmatory data in critically ill children, the practice of using low Vt has been readily adopted in most — if not all — mechanically ventilated pediatric patients. This systematic review by de Jager et al attempted to find an association between various cutoff values for Vt and mortality in mechanically ventilated patients younger than 18 years. The authors searched MEDLINE, EMBASE and CINAHL for randomized clinical trials and observational studies, ultimately analyzing eight studies.
A relationship between Vt and mortality in mechanically ventilated children could not be identified, irrespective of the severity of disease. The reasons for this are multifactorial. Most importantly, the authors admit to significant heterogeneity among the pooled studies, which clearly affected their ability to demonstrate any association between Vt and mortality.
Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.