Relationship between monitored elements and prescribed ventilator setting modifications in critically ill children
Pediatric intensivists have a multiplicity of elements available to guide them in mechanical ventilator decision-making; however, no prospective studies describe which elements intensivists currently use to make ventilator setting changes. Objectives: We describe the current practice of ventilator setting modification in the intensive care unit at Sainte-Justine Hospital, a tertiary care pediatric hospital. Hypothesis: Eighty percent of ventilator settings affecting carbon dioxide clearance are based on the PCO2 or pH while eighty percent of settings affecting oxygenation are based on pulse oximetry.  Methods: Caregivers recorded the primary element and any secondary elements leading to a ventilator setting change at the time of the change via a custom-designed data gathering software.  Results: We included twenty patients. Of a combined 194 changes affecting CO2 clearance, 42.3% ±7.0% were in reference to blood PCO2 or pH.  Of forty-one changes to positive end-expiratory pressure, 34.1% ±14.5% were in reference to pulse oximetry, as were 84.5% ±2.5% of the 813 changes to the fraction of inspired oxygen. Conclusion:  Physicians over-estimate the role of blood pH and PCO2 in their ventilator management, while under-estimating the role of other elements.  Improving our understanding of current practice patterns can help in the development of systems to aid in clinical decision-making in mechanical ventilation, improving clinical outcomes.
Mechanical ventilation Practice patterns Pediatric intensive care