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Indian Journal of Trauma and Emergency Pediatrics 2(3):p 111-120, July - September 2010. | DOI:
Review Article
Protecting the pediatric lung in emergency room: Practical measures
Giuseppe A. Marraro , Giuseppe A. Marraro
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Indian Journal of Trauma and Emergency Pediatrics 2(3):p 111-120, July - September 2010. | DOI:
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Abstract
Baro- and volutrauma, surfactant deficiency, oxygen toxicity, and the development of atelectasis have been investigated in depth in recent years in order to protect the lung during ventilation and reduce the risk of ventilation induced lung injury (vili). Protective lung strategies have been implemented in a variety of clinical contexts that require transferring to emergency room., Pressure ventilation can control the risk of elevated airway pressure (pip) but does not assure less damage to the lung. Tidal volumeappears to be more damaging for the lung as it can favour lung over-distension or create hypoventilation, both harmful clinical conditions for the lung. Peep plays an important role in avoiding the closure and re-opening of the terminal bronchioles implicated in lung damage, and in maintaining the alveolus continuously open. Peep improves oxygenation (increase of functional residual capacity – frc) and can reduce the need for high fio2 (less oxygen toxicity). Maintaining the lung distended for 8-15 seconds at the end of inspiration appears to be helpful in lung recruitment strategy and in the resolution of atelectasis., Ventilation of a child in emergency needs skill and competence that must be acquired in ordinary routine and not in critical care
Key words: emergency, emergency room, lung protective strategy, ventilation, baro-volutrauma, oxygen toxicity, atelectasis, infant, children.
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