Recent advances in paediatric ventilation.

BACKGROUND To review the recent advances in ventilatory therapy for acute respiratory failure in children. DATA SOURCES Recent published peer-review articles on mechanical ventilation for acute respiratory failure in children. SUMMARY OF REVIEW Advances in conventional treatment for acute respiratory failure (e.g. mechanical ventilation) have not increased survival in children. However, recent therapies including high frequency ventilation, extracorporeal membrane oxygenation, nitric oxide and liquid ventilation have reported improved outcomes. The rationale and use of each are presented. CONCLUSIONS High frequency ventilation exists in three forms, although only high frequency oscillation appears to show any benefit in the management of acute respiratory failure refractory to conventional mechanical ventilation. Extracorporeal oxygenation has halved mortality in neonates with acute respiratory failure, and has been used successfully in non-neonate patients. Inhaled nitric oxide from 6 to 20 parts per million improves oxygenation in paediatric patients with acute respiratory failure and congenital heart disease (particularly in the presence of pulmonary arterial hypertension). Liquid ventilation or perfluorocarbon-associated gas exchange has also been used to treat acute respiratory failure in paediatric patients, with partial liquid ventilation particularly appearing to show promise.