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Title The influence of ventilation settings on renal and myocardial dysfunction in mechanically ventilated children.
Keywords mechanical ventilation Multi-organ failure Ventilator induced lung injury
Researchers J. van Dijk
Dr. M.C.J. Kneyber
Nature of the research Retrospective observational study
Fields of study pediatrics intensive care
Background / introduction
Almost 64% of all mechanically ventilated children receive ventilation for at least 24 hours. Despite the fact that this treatment is life-saving, it is also life threatening because of the major complications associated with it.
Most important complication is the development of ventilator induced lung injury, which is based on two principles. First, the frequently opening and closing of the alveoli or given volumes that overstretch the membranes what will lead to irritation of the alveolar membrane (volutrauma). Second mechanism behind VILI, is the release of mediators in the cell membranes of the alveoli whereas pre-existent lung injury can aggravate, a process called biotrauma, where eventually failure of multiple organs is known.
By setting a certain amount of positive end expiratory pressure (PEEP), prevention of developing volutrauma is achieved. However, no paediatric guidelines are available for ultimate titration of PEEP and as a result of this, PEEP settings are made on intuition and experience of the clinician.
The lack of evidence based guidelines is al also shown by the titration fraction inspired oxygen (FiO2), FiO2 is essential to achieve sufficient arterial oxygen levels in a respiratory compromised patient. Natural air includes 21% oxygen, levels of 100% oxygen are available in the setting of mechanical ventilation. Literature, however, suggest that levels >40% are toxic and can induce lung inflammation and eventually lead to the systemic oxygen toxicity syndrome.
The aim of this study is to give a better insight in the levels of PEEP and FiO2 related to peripheral saturations and the correlation between dangerous ventilator settings and multi organ failure (renal and myocardial dysfunction).
Research question / problem definition
What is the influence of PEEP and FiO2 on renal and myocardial dysfunction?
Workplan
The student will participate in the ongoing research projects at the Pediatric Intensive Care unit. The aim of the project is support a ongoing study with finishing a database, helping analyzing the data and eventually writing an scientific report. The student will be supervised by an MD/PhD student. The project will be performed at the pediatric intensive care unit of the Beatrix Children Hospital of the UMCG. The detailed work plan will be determined and discussed together with the student.
References
1. Farias JA, Frutos F, Esteban A, Flores JC, Retta A, Baltodano A, Alia I, Hatzis T, Olazarri F, Petros A, Johnson M. What is the daily practice of mechanical ventilation in pediatric intensive care units? A multicenter study. Intensive Care Med 2004;30:918-925.
2. Randolph AG, Meert KL, O'Neil ME, Hanson JH, Luckett PM, Arnold JH, Gedeit RG, Cox PN, Roberts JS, Venkataraman ST, Forbes PW, Cheifetz IM, Pediatric Acute Lung I, Sepsis Investigators N. The feasibility of conducting clinical trials in infants and children with acute respiratory failure. Am J Respir Crit Care Med 2003;167:1334-1340.
3. Tremblay LN, Slutsky AS. Ventilator-induced lung injury: From the bench to the bedside. Intensive Care Med 2006;32:24-33.
4. Jackson RM. Pulmonary oxygen toxicity. Chest. 1985;88(6):900-905.
5. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-354.
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