Application of the acute respiratory distress syndrome network low-tidal volume strategy to pediatric acute lung injury.

In summary, most of the available data suggest that pediatric patients should be ventilated with low tidal volumes. The 6-mL/kg IBW tidal volume strategy as used in the ARDSNet studies is a reasonable target, having since been rigorously tested in several large, clinical trials (adult and pediatric). The mortality associated with ALI in these studies has never been lower, certainly supporting continued use of the 6 mL/kg target tidal volume as the "gold standard" and, thus, eliminating any equipoise in designing a pediatric trial comparing 6 mL/kg to a larger tidal volume. With mortality rates in children from ALI nearing 8% to 22% and with no clear surrogate outcomes identified to date, the sample sizes needed to show a significant clinical effect would be prohibitively large. Nonetheless, future research should compare 6 mL/kg IBW to even smaller tidal volumes or to high frequency ventilation in an attempt to further reduce the mortality associated with ALI and ARDS in the pediatric population.