We compared these 4 methods to determine whether one method may be better suited to prescribe tidal volume and provide lung protective ventilation strategies than the others. However, there is no gold standard method to determine IBW in children.įour IBW methods are commonly used in pediatrics: ( 1) National Center for Health Statistics data tables( 7), ( 2) the McLaren method( 8), ( 3) the Moore method( 9), and ( 4) the body mass index (BMI) method( 10). It makes sense, then, that IBW be used for the prescription of tidal volumes in pediatric ARDS( 4– 6). Height, and therefore IBW, are excellent predictors of lung volume, which increases as the size of the thoracic cavity increases. Ideal body weight (IBW), also referred to as predicted body weight, is a calculated weight determined for a specific age or height that is deemed optimal for nutritional status( 3). Recently, the Pediatric Acute Lung Injury Consensus Conference recommended a similar strategy, stating “tidal volumes should be 3–6 mL/kg predicted body weight for patients with poor respiratory system compliance and closer to the physiologic range (5–8 mL/kg ideal body weight) for patients with better preserved respiratory system compliance”( 2). This is based on the assumption that volutrauma might be minimized by delivering a volume appropriate to the patient’s lung capacity( 1). A key element of a lung protective strategy is the application of a minimal tidal volume scaled to a predicted rather than actual body weight. Lung protective ventilation strategy has become the standard of care in adults with acute respiratory distress syndrome (ARDS)( 1).
TIDAL VOLUME CALCULATOR TV
The McLaren method had the best agreement with all other methods, and yielded similar prescribed TV in 2–10 year olds and lower TV in ≥10 years old. This variance was greatest between Moore and BMI methods with ≥10Kg difference in IBW in some subjects.
In comparing each method to the others, there was great variance, particularly in ≥10 year olds. NCHS, McLaren and Moore methods could calculate IBW in ≥90%, while BMI method was successful in only 61% due to no BMI validation in <2 year olds. Only 55% could have IBW measured by all four methods. We a priori defined the better method to be one that could calculate IBW in most subjects, had good agreement with other methods, and led to a lower TV.
0 kommentar(er)
