PERMISSIVE HYPERCAPNIA AS A VENTILATORY STRATEGY IN BURNED CHILDREN - EFFECT ON BAROTRAUMA, PNEUMONIA, AND MORTALITY

Objective: To document the incidence of barotrauma, pneumonia, and respiratory death associated with a mechanical ventilation protocol based on permissive hypercapnia in pediatric burn patients. Design: Retrospective review. Materials and Methods: Patients were managed using a mechanical ventilation protocol based on permissive hypercapnia, tolerating moderate (pH>7.20) respiratory acidosis to keep inflating pressures below 40 cm H2O. Main Results: Over a 2.5-year interval, 54 burned children (11% of 395 acute admissions) with an average age of 6.5 years (range 5 weeks to 17 years), average burn size of 44% (range 0 to 98%), and median burn size of 46% required mechanical ventilatory support for an average of 12.5 days (range 1 to 56 days). Inhalation injury was diagnosed in 34 (63%) of the children and 72% percent were admitted within 24 hours of injury. Overt barotrauma occurred in 5.6% of the patients, pneumonia in 32%, and respiratory death in 0%. Conclusions: A conventional ventilation protocol based on permissive hypercapnia is associated with acceptable rates of barotrauma and pneumonia. The low incidence of respiratory death associated with this strategy suggests that it also minimizes ventilator-induced lung injury.