Similarly, optimal PEEP has not been well-studied, with a general acceptance of higher levels of F iO 2 and less aggressive PEEP titration as compared with adults. No target tidal volume range has consistently been associated with outcomes, and compliance with delivering specific tidal volume ranges has been poor. Low tidal volume ventilation has been generally accepted for pediatric patients, even in the absence of supporting evidence. Therefore, most neonatal and pediatric mechanical ventilation practices have been arbitrarily adapted from adult protocols, neglecting the differences in lung pathophysiology, response to injury, and co-morbidities among the three groups. The most recent and universally accepted guidelines for pediatric lung injury are based on consensus opinion rather than objective data. Despite this, pediatric lung injury and mechanical ventilation has been poorly studied, with the majority of investigations being observational or retrospective and with only a few randomized controlled trials to guide intensivists. Pediatric acute respiratory distress syndrome (PARDS) remains a significant cause of morbidity and mortality, with mortality rates as high as 50% in children with severe PARDS.
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