Paeds Cases · acute-care-resuscitation-and-toxicology
Mechanical ventilation principles in children — structured clinical encounter
Structured encounter testing the approach to an 8-year-old with severe pneumonia evolving into paediatric acute respiratory distress syndrome: confirming tube placement, choosing lung-protective settings against the PALICC-2 targets, monitoring plateau pressure and the oxygenation index, and planning ventilator liberation with post-extubation support.
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Station brief (candidate)
You are the paediatric registrar in the paediatric intensive care unit. An 8-year-old has just been intubated for severe pneumonia and is now diagnosed with paediatric acute respiratory distress syndrome. The team asks you to confirm the airway is safe, set the lung-protective ventilator strategy and justify it, describe how you will monitor the child, and outline the plan for eventual liberation. You have 12 minutes with the team and 5 minutes for examiner discussion. [2]
References5ShowHide
- [1]Pediatric Acute Lung Injury Consensus Conference Group Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med, 2015.PMID 25647235
- [2]Emeriaud G; López-Fernández YM; Iyer NP; Blackwood B; Curley MAQ; Dobyns EL; et al Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Pediatr Crit Care Med, 2023.PMID 36661420
- [3]Kneyber MCJ; de Luca D; Calderini E; Jarreau PH; Javouhey E; Lopez-Fernandez Y; et al Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Med, 2017.PMID 28936698
- [4]Abu-Sultaneh S; Iyer NP; Fernández A; Bauman S; Carroll CL; Cheifetz IM; et al Executive Summary: International Clinical Practice Guidelines for Pediatric Ventilator Liberation, A Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Document. Am J Respir Crit Care Med, 2023.PMID 36583619
- [5]Wong JJM; Dang H; Gan CS; Phua HP; Goh RSY; Mok YH; et al Lung-Protective Ventilation for Pediatric Acute Respiratory Distress Syndrome: A Nonrandomized Controlled Trial. Crit Care Med, 2024.PMID 38920618