The top ten unknowns in paediatric mechanical ventilation

There is inconsistent mechanical ventilation (MV) practice in children [1] given the fact that even today it is largely based on expert opinion and data extrapolation from adults despite the paediatric catchphrase “a child is not just a small adult”. Unique maturational differences related to lung growth and maturation (to the age of about 8 years), respiratory system development (e.g. small airways, compliant chest wall), immune response and surfactant homeostasis prevent data generated in adults being directly applicable to children. Moreover, a possible age-related susceptibility to ventilator-induced lung injury has been suggested [2]. Furthermore, there is a much larger spectrum of pathologies associated with hypoxemic and/or hypercapnic respiratory failure in infants and children than in adults. Given this context, we identified 10 major unknowns regarding paediatric MV in the following categories: (1) lung “protective” ventilation strategies, (2) concepts to assist spontaneous breathing, (3) use of non-invasive support and (4) weaning from MV