Ventilator-induced lung injury in children

Mechanical ventilation is one of the common lifesaving interventions used in the care of critically ill children admitted to the pediatric intensive care unit. However, it may induce lung inflammation that can cause or aggravates lung injury. Ventilator-induced lung injury (VILI) is defined as acute lung injury inflicted or aggravated by mechanical ventilation. In the presence of preexisting lung disease (pneumonia and acute respiratory distress syndrome), the immune system hyper-reactivity may lead to cascading lung injury due to mechanical ventilation. The possible mechanisms postulated are too high tidal volume (volutrauma), excessive pressure (barotrauma), repetitive opening and closure of alveoli (atelectotrauma), inflammation (biotrauma), oxygen toxicity, adverse heart–lung interactions, deflation-related injuries, effort-related injuries, and genetic variation in expression of inflammatory mediators. Prevention is the most important strategy for VILI by using lung-protective mechanical ventilation strategies to prevent volutrauma, barotrauma, and atelectotrauma. Low tidal volume ventilation, optimal positive end-expiratory pressure and FiO2, limiting plateau pressure, neuromuscular blockers, and prone positioning are some of the important strategies to prevent and treat VILI. VILI has the potential to cause significant morbidity, mortality, and long-term pulmonary sequelae. The clinical relevance of VILI is poorly understood in critically ill children due to lack of pediatric literature, and most of the information are derived from the adult literature. In this review, we will elucidate the epidemiology, etiopathogenesis, clinical evaluation, management, and measures to attenuate or prevent VILI.