Tidal Volume in Pediatric Ventilation: Do You Get What You See?

Abstract

Mechanical ventilators are increasingly evolving into computer-driven devices. These technical advancements have impact on clinical decisions in pediatric intensive care units (PICUs). A good understanding of the design of mechanical ventilators can improve clinical care. Tidal volume (TV) is one of the corner stones of ventilation: multiple technical factors influence the TV and, thus, influence clinical decision making. Ventilator manufacturers make various design choices regarding the phase, site and conditions of TV measurement as well as algorithmic processing choices. Such choice may impact the measurement and subsequent display of TV. A software change of the TV measuring algorithm of the SERVO-i^® (Getinge, Solna, Sweden) at the PICU of the University Medical Centre Utrecht was studied in a prospective cohort. It showed, as example, a clinically significant impact of 8% difference in reported TV. Design choices in both the hardware and software of mechanical ventilators can have a clinically relevant impact on the measurement of tidal volume. In our search for the optimal TV for lung-protective ventilation, such choices should be taken into account.

Keywords: clinical perception of technique; pediatric ventilation; software; technical challenges.

Figure 1

Schematic example of a ventilator displaying tidal volume (V_T) under ATPD (A) versus BTPS (B) conditions in a ventilated infant. In (A), inspiratory V was sensed and displayed as 40 mL, however, after heating and humidifying of the gas, the actual delivered V_T was 45 mL. In (B), inspiratory V_T was sensed as 36 mL, but after a (software) correction displayed and delivered as 40 mL.