Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality. Incidence and Outcomes of Pediatric Acute Lung Injury Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study How is Mechanical Ventilation Employed in a Pediatric Intensive Care Unit in Brazil? Lung development and susceptibility to ventilator-induced lung injury. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS. Mortality and morbidity of acute hypoxemic respiratory failure and acute respiratory distress syndrome in infants and young children. Neuromuscular blockers in early acute respiratory distress syndrome. Acute lung injury in pediatric intensive care in Australia and New Zealand—A prospective, multicenter, observational study* Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. We should abandon randomized controlled trials in the intensive care unit National Institute of Child Health and Human Development Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group.
RATIONALE The 1994 American European Consensus Committee definitions of acute lung injury ( ALI ) and the acute respiratory distress syndrome ( ARDS ) have not been applied systematic ally in the pediatric population . OBJECTIVES The purpose of this study was to evaluate prospect ively the epidemiology and clinical risk factors associated with death and prolonged mechanical ventilation in all pediatric patients admitted to two large , pediatric intensive care units with ALI/ARDS using Consensus criteria . METHODS All pediatric patients meeting Consensus Committee definitions for ALI were prospect ively identified and included in a relational data base . MEASUREMENTS AND MAIN RESULTS There were 328 admissions for ALI/ARDS with a mortality of 22 % . Multivariate logistic regression analyses revealed ( 1 ) the initial severity of oxygenation defect , as measured by the Pa(O2)/FI(O2 ) ratio ; ( 2 ) the presence of nonpulmonary and non- central nervous system ( CNS ) organ dysfunction ; and ( 3 ) the presence of CNS dysfunction were independently associated with mortality and prolonged mechanical ventilation . A substantial fraction of patients ( 28 % ) did not require mechanical ventilation at the onset of ALI ; 46 % of these patients eventually required intubation for worsening ALI . CONCLUSIONS Mortality in pediatric ALI/ARDS is high and several risk factors have major prognostic value . In contrast to ALI/ARDS in adults , the initial severity of arterial hypoxemia in children correlates well with mortality . A significant fraction of patients with pediatric ALI/ARDS can be identified before endotracheal intubation is required . These patients provide a valuable group in whom new therapies can be tested OBJECTIVE : This population -based , prospect i ve , cohort study was design ed to determine the population incidence and outcomes of pediatric acute lung injury . METHODS : Between 1999 and 2000 , 1 year of screening was performed at all hospitals admitting critically ill children in King County , Washington . County residents 0.5 to 15 years of age who required invasive ( through endotracheal tube or tracheostomy ) or noninvasive ( through full face mask ) mechanical ventilation , regardless of the duration of mechanical ventilation , were screened . From this population , children meeting North American-European Consensus Conference acute lung injury criteria were eligible for enrollment . Postoperative patients who received mechanical ventilation for < 24 hours were excluded . Data collected included the presence of predefined cardiac conditions , demographic and physiological data , duration of mechanical ventilation , and deaths . US Census population figures were used to estimate incidence . Associations between outcomes and subgroups identified a priori were assessed . RESULTS : Thirty-nine children met the criteria for acute lung injury , result ing in a calculated incidence of 12.8 cases per 100000 person-years . Severe sepsis ( with pneumonia as the infection focus ) was the most common risk factor . The median 24-hour Pediatric Risk of Mortality III score was 9.0 , and the mean ± SD was 11.7 ± 7.5 . The hospital mortality rate was 18 % , lower than that reported previously for pediatric acute lung injury . There were no statistically significant associations between age , gender , or risk factors and outcomes . CONCLUSIONS : We present the first population -based estimate of pediatric acute lung injury incidence in the United States . Population incidence and mortality rates are lower than those for adult acute lung injury . Low mortality rates in pediatric acute lung injury may necessitate clinical trial outcome measures other than death BACKGROUND Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung injury and the acute respiratory distress syndrome . We therefore conducted a trial to determine whether ventilation with lower tidal volumes would improve the clinical outcomes in these patients . METHODS Patients with acute lung injury and the acute respiratory distress syndrome were enrolled in a multicenter , r and omized trial . The trial compared traditional ventilation treatment , which involved an initial tidal volume of 12 ml per kilogram of predicted body weight and an airway pressure measured after a 0.5-second pause at the end of inspiration ( plateau pressure ) of 50 cm of water or less , with ventilation with a lower tidal volume , which involved an initial tidal volume of 6 ml per kilogram of predicted body weight and a plateau pressure of 30 cm of water or less . The primary outcomes were death before a patient was discharged home and was breathing without assistance and the number of days without ventilator use from day 1 to day 28 . RESULTS The trial was stopped after the enrollment of 861 patients because  mortality was lower in the group treated with lower tidal volumes than in the group treated with traditional tidal volumes ( 31.0 percent vs. 39.8 percent , P=0.007 ) , and the number of days without ventilator use during the first 28 days after r and omization was greater in this group ( mean [ + /-SD ] , 12+/-11 vs. 10+/-11 ; P=0.007 ) . The mean tidal volumes on days 1 to 3 were 6.2+/-0.8 and 11.8+/-0.8 ml per kilogram of predicted body weight ( P<0.001 ) , respectively , and the mean plateau pressures were 25+/-6 and 33+/-8 cm of water ( P<0.001 ) , respectively . CONCLUSIONS In patients with acute lung injury and the acute respiratory distress syndrome , mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use Objective To describe the daily practice of mechanical ventilation ( MV ) , and secondarily , its outcome in pediatric intensive care units ( PICUs ) . Design Prospect i ve cohort of infants and children who received MV for at least 12 h. Setting Thirty-six medical surgical PICUs . Patients All consecutive patients admitted to the PICUs during 2-month period . Measurements and main results Of the 1893 patients admitted , 659 ( 35 % ) received MV for a median time of 4 days ( 25th percentile , 75 % : 2 , 6 ) . Median of age was 13 months ( 25th percentile , 75 % : 5 , 48 ) . Common indications for MV were acute respiratory failure ( ARF ) in 72 % of the patients , altered mental status in 14 % of the patients , and ARF on chronic pulmonary disease in 10 % of the patients . Median length of stay in the PICUs was 8 days ( 25th percentile , 75 % : 5 , 13 ) . Overall mortality rate in the PICUs was 15 % ( confidence interval 95 % : 13–18 ) for the entire population , 50 % ( 95 % CI : 25–74 ) in patients who received MV because of acute respiratory distress syndrome , 24 % ( 95 % CI : 16–35 ) in patients who received MV for altered mental status and 16 % ( 95 % CI : 9–29 ) in patients who received MV for ARF on chronic pulmonary disease . Conclusion One in every 3 patients admitted to the PICUs requires ventilatory support .. The ARF was the most common reason for MV , and survival of unselected infants and children receiving MV for more than 12 h was 85 % OBJECTIVE : to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo , Brazil . DESIGN : Prospect i ve cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more , between October 1st , 2005 and March 31st , 2006 . RESULTS : Of the 241 patients admitted , 86 ( 35.7 % ) received mechanical ventilation for 24  hours  or more . Of these , 49 met inclusion criteria and were thus eligible to participate in the study . Of the 49 patients studied , 45 had chronic functional status . The median age of participants was 32 months and the median length of mechanical ventilation use was 6.5 days . The major indication for mechanical ventilation was acute respiratory failure , usually associated with severe sepsis / septic shock . Pressure ventilation modes were the st and ard ones . An overall 10.37 % incidence of Acute Respiratory Distress Syndrome was found , in addition to tidal volumes > 8 ml/kg , as well as normo- or hypocapnia . A total of 17 children died . Risk factors for mortality within 28 days of admission were initial inspiratory pressure , pH , PaO2/FiO2 ratio , oxygenation index and also oxygenation index at 48 hours of mechanical ventilation . Initial inspiratory pressure was also a predictor of mechanical ventilation for periods longer than 7 days . CONCLUSION : Of the admitted children , 35.7 % received mechanical ventilation for 24 h or more . Pressure ventilation modes were st and ard . Of the children studied , 91 % had chronic functional status . There was a high incidence of Acute Respiratory Distress Syndrome , but a lung-protective strategy was not fully implemented . Inspiratory pressure at the beginning of mechanical ventilation was a predictor of mortality within 28 days and of a longer course of mechanical ventilation RATIONALE Ventilator-induced lung injury has been predominantly studied in adults . OBJECTIVES To explore the effects of age and lung development on susceptibility to such injury . METHODS Ex vivo isolated nonperfused rat lungs ( infant , juvenile , and adult ) were mechanically ventilated where VT was based on milliliters per kilogram of body weight or as a percentage of the measured total lung capacity ( TLC ) . In vivo anesthetized rats ( infant , adult ) were mechanically ventilated with pressure-limited VTs . Allocation to ventilation strategy was r and omized . MEASUREMENTS Ex vivo injury was assessed by pressure-volume analysis , reduction in TLC , and histology , and in vivo injury by lung compliance , cytokine production , and wet- to dry-weight ratio . MAIN RESULTS Ex vivo ventilation ( VT 30 ml.kg(-1 ) ) result ed in a significant reduction ( 36.0 + /- 10.1 % , p < 0.05 ) in TLC in adult but not in infant lungs . Ex vivo ventilation ( VT 50 % TLC ) result ed in a significant reduction in TLC in both adult ( 27.8 + /- 2.8 % ) and infant ( 10.6 + /- 7.0 % ) lungs , but more so in the adult lungs ( p < 0.05 ) ; these changes were paralleled by histology and pressure-volume characteristics . After high stretch in vivo ventilation , adult but not infant rats developed lung injury ( total lung compliance , wet/dry ratio , tumor necrosis factor alpha ) . Surface video microscopy demonstrated greater heterogeneity of alveolar distension in ex vivo adult versus infant lungs . CONCLUSION These data provide ex vivo and in vivo evidence that comparable ventilator setting s are significantly more injurious in the adult than infant rat lung , probably reflecting differences in intrinsic susceptibility or inflation pattern Because animal studies have demonstrated that mechanical ventilation at high volume and pressure can be deleterious to the lungs , limitation of airway pressure , allowing hypercapnia if necessary , is already used for ventilation of acute respiratory distress syndrome ( ARDS ) . Whether a systematic and more drastic reduction is necessary is debatable . A multicenter r and omized study was undertaken to compare a strategy aim ed at limiting the end-inspiratory plateau pressure to 25 cm H2O , using tidal volume ( VT ) below 10 ml/kg of body weight , versus a more conventional ventilatory approach ( with regard to current practice ) using VT at 10 ml/kg or above and close to normal PaCO2 . Both arms used a similar level of positive end-expiratory pressure . A total of 116 patients with ARDS and no organ failure other than the lung were enrolled over 32 mo in 25 centers . The two groups were similar at inclusion . Patients in the two arms were ventilated with different VT ( 7.1 + /- 1.3 versus 10.3 + /- 1.7 ml/kg at Day 1 , p < 0.001 ) and plateau pressures ( 25.7 + /- 5 . 0 versus 31.7 + /- 6.6 cm H2O at Day 1 , p < 0.001 ) , result ing in different PaCO2 ( 59.5 + /- 15.0 versus 41.3 + /- 7.6 mm Hg , p < 0.001 ) and pH ( 7.28 + /- 0.09 versus 7.4 + /- 0.09 , p < 0.001 ) , but a similar level of oxygenation . The new approach did not reduce mortality at Day 60 ( 46.6 % versus 37.9 % in control subjects , p = 0.38 ) , the duration of mechanical ventilation ( 23.1 + /- 20.2 versus 21.4 + /- 16 . 3 d , p = 0.85 ) , the incidence of pneumothorax ( 14 % versus 12 % , p = 0 . 78 ) , or the secondary occurrence of multiple organ failure ( 41 % versus 41 % , p = 1 ) . We conclude that no benefit could be observed with reduced VT titrated to reach plateau pressures around 25 cm H2O compared with a more conventional approach in which normocapnia was achieved with plateau pressures already below 35 cm H2O BACKGROUND Acute hypoxemic respiratory failure ( AHRF ) often develops acute respiratory distress syndrome ( ARDS ) , and its incidence and mortalities in critically ill pediatric patients in China were 2 % and 40 % respectively . This study aim ed at prospect ively investigating incidence , causes , mortality and its risk factors , and any relationship to initial tidal volume ( V(T ) ) levels of mechanical ventilation , in children £ 5 years of age with AHRF and ARDS . METHODS In 12 consecutive months in 23 pediatric intensive care units ( PICU ) , AHRF and ARDS were identified in those requiring > 12 hour intratracheal mechanical ventilation and followed up for 90 days or until death or discharge . ARDS was diagnosed according to the American-European Consensus definitions . The mortality and ventilation free days ( VFD ) were measured as the primary outcome , and major complications , initial disease severity , and burden were measured as the secondary outcome . RESULTS In 13 491 PICU admissions , there were 439 AHRF , of which 345 ( 78.6 % ) developed ARDS , result ing in incidences of 3.3 % and 2.6 % , and corresponding mortalities of 30.3 % and 32.8 % respectively along with 8.2 and 6.7 times of relative risk of death in those with pneumonia ( 62.9 % ) and sepsis ( 33.7 % ) as major underlying diseases respectively . No association was found in V(T ) levels during the first 7 days with mortality , nor for V(T ) at levels < 6 , 6 - 8 , 8 - 10 , and > 10 ml/kg in the first 3 days with mortality or length of VFD . By binary Logistic regression analyses , higher pediatric risk of mortality score III , higher initial oxygenation index , and age < 1 year were associated with higher mortality or shorter VFD in AHRF . CONCLUSIONS The incidence and mortalities of AHRF and ARDS in children £ 5 years were similar to or lower than the previously reported rates ( in age up to 15 years ) , associated with initial disease severity and other confounders , but causal relationship for the initial V(T ) levels as the independent factor to the major outcome was not found BACKGROUND In patients undergoing mechanical ventilation for the acute respiratory distress syndrome ( ARDS ) , neuromuscular blocking agents may improve oxygenation and decrease ventilator-induced lung injury but may also cause muscle weakness . We evaluated clinical outcomes after 2 days of therapy with neuromuscular blocking agents in patients with early , severe ARDS . METHODS In this multicenter , double-blind trial , 340 patients presenting to the intensive care unit ( ICU ) with an onset of severe ARDS within the previous 48 hours were r and omly assigned to receive , for 48 hours , either cisatracurium besylate ( 178 patients ) or placebo ( 162 patients ) . Severe ARDS was defined as a ratio of the partial pressure of arterial oxygen ( PaO2 ) to the fraction of inspired oxygen ( FIO2 ) of less than 150 , with a positive end-expiratory pressure of 5 cm or more of water and a tidal volume of 6 to 8 ml per kilogram of predicted body weight . The primary outcome was the proportion of patients who died either before hospital discharge or within 90 days after study enrollment ( i.e. , the 90-day in-hospital mortality rate ) , adjusted for predefined covariates and baseline differences between groups with the use of a Cox model . RESULTS The hazard ratio for death at 90 days in the cisatracurium group , as compared with the placebo group , was 0.68 ( 95 % confidence interval [ CI ] , 0.48 to 0.98 ; P=0.04 ) , after adjustment for both the baseline PaO2:FIO2 and plateau pressure and the Simplified Acute Physiology II score . The crude 90-day mortality was 31.6 % ( 95 % CI , 25.2 to 38.8 ) in the cisatracurium group and 40.7 % ( 95 % CI , 33.5 to 48.4 ) in the placebo group ( P=0.08 ) . Mortality at 28 days was 23.7 % ( 95 % CI , 18.1 to 30.5 ) with cisatracurium and 33.3 % ( 95 % CI , 26.5 to 40.9 ) with placebo ( P=0.05 ) . The rate of ICU-acquired paresis did not differ significantly between the two groups . CONCLUSIONS In patients with severe ARDS , early administration of a neuromuscular blocking agent improved the adjusted 90-day survival and increased the time off the ventilator without increasing muscle weakness . ( Funded by Assistance Publique-Hôpitaux de Marseille and the Programme Hospitalier de Recherche Clinique Régional 2004 - 26 of the French Ministry of Health ; Clinical Trials.gov number , NCT00299650 . Objective : Acute lung injury ( ALI ) is poorly defined in children . The objective of this prospect i ve study was to clarify the incidence , demographics , management strategies , outcome , and mortality predictors of ALI in children in Australia and New Zeal and . Design : Multicenter prospect i ve study during a 12-month period . Setting : Intensive care unit . Patients : All children admitted to intensive care and requiring mechanical ventilation  were screened daily for development of ALI based on American-European Consensus Conference guidelines . Identified patients were followed for 28 days or until death or discharge . Interventions : None . Measurements and Main Results : There were 117 cases of ALI during the study period , giving a population incidence of 2.95/100,000 < 16 yrs . ALI accounted for 2.2 % of pediatric intensive care unit admissions . Mortality was 35 % for ALI , and this accounted for 30 % of all pediatric intensive care unit deaths during the study period . Significant preadmission risk factors for mortality were chronic disease , older age , and immunosuppression . Predictors of mortality during admission were ventilatory requirements ( peak inspiratory pressures , mean airway pressure , positive end-expiratory pressure ) and indexes of respiratory severity on day 1 ( Pao2/Fio2 ratio and oxygenation index ) . Higher maximum and median tidal volumes were associated with reduced mortality , even when corrected for severity of lung disease . Development of single and multiple organ failure was significantly associated with mortality . Conclusions : ALI in children is uncommon but has a high mortality rate . Risk factors for mortality are easily identified . Ventilatory variables and indexes of lung severity were significantly associated with mortality OBJECTIVE To assess the safety and potential efficacy of a mechanical ventilation strategy design ed to reduce stretch-induced lung injury in acute respiratory distress syndrome . DESIGN Prospect i ve , r and omized , controlled clinical trial . SETTING Eight intensive care units in four teaching hospitals . PATIENTS Fifty-two patients with acute respiratory distress syndrome . INTERVENTIONS Traditional tidal volume patients : tidal volume 10 - 12 mL/kg ideal body weight , reduced if inspiratory plateau pressure was > 55 cm H2O ( 7.3 kPa ) . Small tidal volume patients : tidal volume 5 - 8 mL/kg ideal body weight , to keep plateau pressure < 30 cm H2O ( 4.0 kPa ) . MEASUREMENTS AND MAIN RESULTS Mean tidal volumes during the first 5 days in traditional and small tidal volume patients were 10.2 and 7.3 mL/kg , respectively ( p < .001 ) , with mean plateau pressure = 30.6 and 24.9 cm H2O ( 3.3 kPa ) , respectively ( p < .001 ) . There were no significant differences in requirements for positive end-expiratory pressure or FIO2 , fluid intakes/outputs , requirements for vasopressors , sedatives , or neuromuscular blocking agents , percentage of patients that achieved unassisted breathing , ventilator days , or mortality . CONCLUSIONS The reduced tidal volume strategy used in this study was safe . Failure to observe beneficial effects of small tidal volume ventilation treatment in important clinical outcome variables may have occurred because a ) the sample size was too small to discern small treatment effects ; b ) the differences in tidal volumes and plateau pressures were modest ; or c ) reduced tidal volume ventilation is not beneficial BACKGROUND In patients with the acute respiratory distress syndrome , massive alveolar collapse and cyclic lung reopening and overdistention during mechanical ventilation may perpetuate alveolar injury . We determined whether a ventilatory strategy design ed to minimize such lung injuries could reduce not only pulmonary complications but also mortality at 28 days in patients with the acute respiratory distress syndrome . METHODS We r and omly assigned 53 patients with early acute respiratory distress syndrome ( including 28 described previously ) , all of whom were receiving identical hemodynamic and general support , to conventional or protective mechanical ventilation . Conventional ventilation was based on the strategy of maintaining the lowest positive end-expiratory pressure ( PEEP ) for acceptable oxygenation , with a tidal volume of 12 ml per kilogram of body weight and normal arterial carbon dioxide levels ( 35 to 38 mm Hg ) . Protective ventilation involved end-expiratory pressures above the lower inflection point on the static pressure-volume curve , a tidal volume of less than 6 ml per kilogram , driving pressures of less than 20 cm of water above the PEEP value , permissive hypercapnia , and preferential use of pressure-limited ventilatory modes . RESULTS After 28 days , 11 of 29 patients ( 38 percent ) in the protective-ventilation group had died , as compared with 17 of 24 ( 71 percent ) in the conventional-ventilation group ( P<0.001 ) . The rates of weaning from mechanical ventilation were 66 percent in the protective-ventilation group and 29 percent in the conventional-ventilation group ( P=0.005 ) : the rates of clinical barotrauma were 7 percent and 42 percent , respectively ( P=0.02 ) , despite the use of higher PEEP and mean airway pressures in the protective-ventilation group . The difference in survival to hospital discharge was not significant ; 13 of 29 patients ( 45 percent ) in the protective-ventilation group died in the hospital , as compared with 17 of 24 in the conventional-ventilation group ( 71 percent , P=0.37 ) . CONCLUSIONS As compared with conventional ventilation , the protective strategy was associated with improved survival at 28 days , a higher rate of weaning from mechanical ventilation , and a lower rate of barotrauma in patients with the acute respiratory distress syndrome .  Protective ventilation was not associated with a higher rate of survival to hospital discharge The r and omized controlled trial is seen by many as the summit of evidence -based medicine , yet , in the intensive care unit , r and omized controlled trials can be challenging to conduct , and results are often difficult to interpret and apply . Many r and omized controlled trials in intensive care patients have not demonstrated beneficial effects of the intervention under investigation often despite good pre clinical and even previous r and omized controlled trial evidence . There are many reasons for these negative results including problems with timing , end point selection , and heterogeneous population s. In this article , we will discuss the limitations of r and omized controlled trials in the intensive care unit population and highlight the importance of considering other study design s in the challenging intensive care unit environment The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development BACKGROUND A strategy of mechanical ventilation that limits airway pressure and tidal volume while permitting hypercapnia has been recommended for patients with the acute respiratory distress syndrome . The goal is to reduce lung injury due to overdistention . However , the efficacy of this approach has not been established . METHODS Within 24 hours of intubation , patients at high risk for the acute respiratory distress syndrome were r and omly assigned to either pressure- and volume-limited ventilation ( limited-ventilation group ) , with the peak inspiratory pressure maintained at 30 cm of water or less and the tidal volume at 8 ml per kilogram of body weight or less , or to conventional ventilation ( control group ) , with the peak inspiratory pressure allowed to rise as high as 50 cm of water and the tidal volume at 10 to 15 ml per kilogram . All other ventilatory variables were similar in the two groups . RESULTS A total of 120 patients with similar clinical features underwent r and omization ( 60 in each group ) . The patients in the limited-ventilation and control groups were exposed to different mean ( + /-SD ) tidal volumes ( 7.2+/-0.8 vs. 10.8+/-1.0 ml per kilogram , respectively ; P<0.001 ) and peak inspiratory pressures ( 23.6+/-5.8 vs. 34.0+/-11.0 cm of water , P<0.001 ) . Mortality was 50 percent in the limited-ventilation group and 47 percent in the control group ( relative risk , 1.07 ; 95 percent confidence interval , 0.72 to 1.57 ; P=0.72 ) . In the limited-ventilation group , permissive hypercapnia ( arterial carbon dioxide tension , > 50 mm Hg ) was more common ( 52 percent vs. 28 percent , P=0.009 ) , more marked ( 54.4+/-18.8 vs. 45.7+/-9.8 mm Hg , P=0.002 ) , and more prolonged ( 146+/-265 vs. 25+/-22 hours , P=0.017 ) than in the control group . The incidence of barotrauma , the highest multiple-organ-dysfunction score , and the number of episodes of organ failure were similar in the two groups ; however , the numbers of patients who required paralytic agents ( 23 vs. 13 , P=0.05 ) and dialysis for renal failure ( 13 vs. 5 , P= 0.04 ) were greater in the limited-ventilation group than in the control group . CONCLUSIONS In patients at high risk for the acute respiratory distress syndrome , a strategy of mechanical ventilation that limits peak inspiratory pressure and tidal volume does not appear to reduce mortality and may increase morbidity
OBJECTIVE To determine whether tidal volume is associated with mortality in critically ill , mechanically ventilated children .