Table 5.
The left hand side of the table summarizes the recommendations based on the blood gas, PIP and VR from the pediatric mechanical ventilator protocol. The right hand side describes the changes in PIP or VR made by clinicians in actual practice in response to a blood gas. The middle column (blue shaded cells) represents the number of observations per cell in the ventilation table. The columns to the right of that display the number and percentage (%) of observations in each cell for which clinicians made no change to VR or PIP, changed VR or PIP in the same direction as the protocol recommendation, change VR or PIP opposite the protocol recommendation, or made a combination of increasing one parameter (VR or PIP) and decreasing the other (VR or PIP).
| Cell | pH | PIP | VR | Recommendation | N = 2,719 | No Change | In Line | Opposite | Combination | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| N | % | N | % | N | % | N | % | ||||||
| 1 | > 7.45 | ≤ 28 | All | ↓PIP 2; ↓VR by 20% | 317 | 143 | 45.1 | 158 | 49.8 | 19 | 6 | 3 | 0.9 |
| 2 | 7.30–7.45 | ≤ 28 | All | ↓PIP 2 | 1021 | 651 | 63.8 | 223 | 21.8 | 155 | 15.2 | 8 | 0.8 |
| 3 | 7.15 – 7.29 | ≤ 28 | < 25 | ↑PIP 2; ↑VR by 20% | 126 | 57 | 45.2 | 61 | 48.4 | 13 | 10.3 | 5 | 4 |
| 4 | 7.15 – 7.29 | ≤ 28 | ≥ 25 | ↑PIP 4 | 62 | 23 | 37.1 | 30 | 48.4 | 13 | 21.0 | 4 | 6.5 |
| 5 | < 7.15 | ≤ 28 | < 25 | ↑PIP 4; ↑VR by 20% | 13 | 3 | 23.1 | 10 | 76.9 | 1 | 7.7 | 1 | 7.7 |
| 6 | < 7.15 | ≤ 28 | ≥ 25 | ↑PIP 4 | 5 | 3 | 60 | 2 | 40 | 0 | 0 | 0 | 0 |
| 7 | > 7.45 | 29–35 | All | ↓PIP 2 | 201 | 101 | 50.2 | 85 | 42.3 | 18 | 9 | 3 | 1.5 |
| 8 | 7.30–7.45 | 29–35 | All | ↓PIP 2 | 473 | 288 | 60.9 | 127 | 26.9 | 67 | 14.2 | 9 | 1.9 |
| 9 | 7.15 – 7.29 | 29–35 | < 25 | No Δ PIP; ↑VR | 84 | 38 | 45.2 | 35 | 41.7 | 15 | 17.9 | 4 | 4.3 |
| 10* | 7.15 – 7.29 | 29–35 | ≥ 25 | No Δ PIP | 82 | 44* | 53.7 | 27 | 32.9 | 14 | 17.1 | 3 | 3.7 |
| 11 | < 7.15 | 29–35 | < 25 | ↑PIP 2; ↑VR by 20% | 9 | 2 | 22.2 | 6 | 66.7 | 1 | 11.1 | 0 | 0 |
| 12 | < 7.15 | 29–35 | ≥ 25 | ↑PIP 2 | 13 | 5 | 38.5 | 5 | 38.4 | 4 | 30.8 | 1 | 7.7 |
| 13 | > 7.45 | > 35 | All | ↓PIP 4 | 47 | 17 | 36.2 | 28 | 59.6 | 2 | 4.3 | 0 | 0 |
| 14 | 7.30–7.45 | > 35 | All | ↓PIP 2 | 146 | 78 | 53.4 | 55 | 37.7 | 15 | 10.3 | 2 | 1.4 |
| 15** | 7.15 – 7.29 | > 35 | < 25 | ↓PIP 2; ↑VR by 20% | 37 | 18 | 48.7 | 8 | 21.6 | 13 | 35.1 | 2** | 5.4 |
| 16 | 7.15 – 7.29 | > 35 | ≥ 25 | ↓PIP 2 | 56 | 25 | 44.6 | 22 | 39.3 | 15 | 26.7 | 6 | 10.7 |
| 17 | < 7.15 | > 35 | < 25 | ↑VR by 20% | 6 | 3 | 50 | 2 | 33.3 | 1 | 16.7 | 0 | 0 |
| 18* | < 7.15 | > 35 | ≥ 25 | No Δ PIP | 21 | 10* | 47.6 | 6 | 28.5 | 8 | 38.1 | 3 | 14.3 |
In these two cells the protocol would have recommended no change to PIP or VR—for these cells in line means VR or PIP was increased, Opposite means PIP or VR was decreased.
In this cell the protocol recommended increasing the VR and decreasing the PIP—for this cell in line means VR or PIP was increased, opposite means PIP or VR was decreased.
PIP = Peak Inspiratory Pressure cmH2O; VR = Ventilator Rate (bpm)