The effect of tidal volume on mortality and ventilator free days for children with acute lung injury (ALI)

Objective. To determine whether Tidal Volume (Vt) between 6 and 10 ml/kg affects outcome for children with ALI.;Methods. Review of PICU admissions from 2000-2007. Inclusion criteria were intubation and ventilation with at least one PaO2/FiO 2 ratio < 300.;Results. 398 patients were included. Overall mortality was 20% with a median Vt of 7.4 ml/kg. Median Vt on the first day of mechanical ventilation was lower in the group that died, although not statistically significant (p=0.06). After controlling for year, Delta P (PIP-PEEP), PEEP, and severity of lung disease, Vt was not associated with mortality (p>0.1), but higher Vt on day one of ventilation was associated with more ventilator free days (p<0.05). This was particularly true in patients with better respiratory compliance (OR=0.70, (0.52, 0.95)).;Conclusions. Between 6-10 ml/kg using pressure control ventilation, Vt early in mechanical ventilation is not associated with mortality, and higher Vt is associated with more ventilator free days.