Hanson James H, Flori Heidi
PICU Offices, Children's Hospital & Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA.
Respir Care Clin N Am. 2006 Sep;12(3):349-57. doi: 10.1016/j.rcc.2006.05.003.
In summary, most of the available data suggest that pediatric patients should be ventilated with low tidal volumes. The 6-mL/kg IBW tidal volume strategy as used in the ARDSNet studies is a reasonable target, having since been rigorously tested in several large, clinical trials (adult and pediatric). The mortality associated with ALI in these studies has never been lower, certainly supporting continued use of the 6 mL/kg target tidal volume as the "gold standard" and, thus, eliminating any equipoise in designing a pediatric trial comparing 6 mL/kg to a larger tidal volume. With mortality rates in children from ALI nearing 8% to 22% and with no clear surrogate outcomes identified to date, the sample sizes needed to show a significant clinical effect would be prohibitively large. Nonetheless, future research should compare 6 mL/kg IBW to even smaller tidal volumes or to high frequency ventilation in an attempt to further reduce the mortality associated with ALI and ARDS in the pediatric population.
总之，大多数现有数据表明，儿科患者应采用低潮气量通气。急性呼吸窘迫综合征网络（ARDSNet）研究中使用的6 mL/千克理想体重（IBW）潮气量策略是一个合理的目标，此后已在多项大型临床试验（成人和儿科）中得到严格验证。这些研究中与急性肺损伤（ALI）相关的死亡率从未如此之低，这无疑支持继续将6 mL/千克目标潮气量作为“金标准”，因此，在设计一项比较6 mL/千克与更大潮气量的儿科试验时，不存在任何权衡。由于儿童ALI的死亡率接近8%至22%，且迄今为止尚未确定明确的替代结局，要显示出显著临床效果所需的样本量将大得令人望而却步。尽管如此，未来的研究应将6 mL/千克IBW与更小的潮气量或高频通气进行比较，以进一步降低儿科人群中与ALI和ARDS相关的死亡率。
