A 4-year-old child is intubated and mechanically ventilated for ARDS following pneumonia. The plateau pressure on the ventilator is 34 cmH2O. Which lung-protective strategy is most appropriate?
- A Increase tidal volume to 10 mL/kg to improve oxygenation
- B Use tidal volume of 6 mL/kg ideal body weight and limit plateau pressure below 30 cmH2O ✓
- C Use high-frequency oscillatory ventilation as first-line strategy
- D Decrease PEEP to below 5 cmH2O to prevent barotrauma
Correct answer: B. Use tidal volume of 6 mL/kg ideal body weight and limit plateau pressure below 30 cmH2O
Explanation
Lung-protective ventilation for pediatric ARDS uses low tidal volumes (6 mL/kg ideal body weight) and limits plateau pressure to ≤28–30 cmH2O to prevent ventilator-induced lung injury (volutrauma and barotrauma). Higher tidal volumes worsen lung injury. HFOV is considered a rescue therapy, not first-line. Adequate PEEP (typically 5–10 cmH2O or titrated by FiO2-PEEP tables) maintains alveolar recruitment.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.