Ventilator Settings in Critically Ill Pediatric Patients (VESPer)—insights from a European Registry

Aim To explore ventilator settings, ventilation variables and parameters in critically ill pediatric patients across European Centers. Methods International, multicenter, prospective observational study, collecting ventilation data for 7 days from patients aged ≤ 12 years, requiring ventilatory support for ≥ 12 h. Primary endpoint was a set of key ventilator settings, including tidal volume (VT), respiratory rate (RR), peak and mean airway pressure (Ppeak and Pmean), positive end–expiratory pressure (PEEP), and the fraction of inspired oxygen (FiO2). Ventilator settings were compared across neonates (aged < 1 month), infants (1 to 12 months), toddlers (1 to 3 years) and children (4 to 12 years), and between patients with and without pediatric acute respiratory distress syndrome (PARDS). Results Patients enrolment occurred in 43 centers in 11 countries, with a total of 166 patients—mostly infants—included in this analysis. The majority began with invasive ventilation, while one–third started with noninvasive ventilation (NIV) or high–flow nasal oxygen (HFNO). Patients on invasive ventilation, NIV and HFNO were weaned within a median of 3 [2–6], 3 [2–4] and 3 [2–4] days, respectively. In 22% of patients, NIV or HFNO was used following invasive ventilation. VT, RR and FiO2 varied across age groups, and airway pressures were higher in PARDS patients. Conclusions In this cohort, ventilator settings, and ventilation variables and parameters, varied between individual patients and across patient groups. Larger studies are needed to confirm this variability, explore associations between ventilation practices and clinical outcomes, and assess temporal and geo–economic differences.