• Katherine A Sward, NewthChristopher J LCJL, Robinder G Khemani, Kent Page, Kathleen L Meert, Joseph A Carcillo, Thomas P Shanley, Frank W Moler, Murray M Pollack, Heidi J Dalton, David L Wessel, John T Berger, Robert A Berg, Rick E Harrison, Allan Doctor, J Michael Dean, Richard Holobkov, Tammara L Jenkins, Carol E Nicholson, and Eunice Kennedy Shriver National Institute for Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN).
• 1University of Utah College of Nursing, Salt Lake City, UT. 2Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA. 5Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 6Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 9Department of Pediatrics, University of Michigan, Ann Arbor, MI. 10Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 12Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 13Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 14Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 15Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD. 16Formerly Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD.
• Pediatr Crit Care Me. 2017 Nov 1; 18 (11): 1027-1034.

ObjectivesTo examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome.DesignSurvey/questionnaire.SettingThe eight PICUs in the Collaborative Pediatric Critical Care Research Network.ParticipantsOne hundred twenty-two physicians (attendings and fellows).InterventionsNone.Measurements And Main ResultsWe used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for FIO2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables.ConclusionsAlthough overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.

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