Evaluation of Respiratory Function of PMVed Children

Evaluation of respiratory function is an invaluable component of clinical care of the PMVed child and when used appropriately can inform decision-making for the direct benefit of the patient. The range of available testing methods available in the modern critical care setting can feel overwhelming, with clinicians tempted by evermore elaborate options, and it is important to ensure that assessment approaches are selected based on a robust understanding of the potential benefits. This chapter discusses the main tools currently available for assessment of respiratory function in the PMVed child, including a number of approaches whose primary application is currently in a research setting. The chapter covers routinely available clinical methods (ventilator-based measures, standard clinical observations), more classical physiological approaches (respiratory muscle assessments, chest wall measurements, flow- and pressure-based parameters) and novel tools such as electrical impedance tomography and lung ultrasound. As with so many other aspects of paediatric medicine, the eternally frustrating issue of the evidence base for many of these tools being far stronger in the adult population abounds here too. Nevertheless, many of these tools have the potential to generate valuable insight into the patient’s condition and therefore may be useful to guide decision-making, even if the literature is relatively sparse. The reader is encouraged to adopt a critical approach to selection of tools for use in their own clinical practice, with the central question of ‘what will I do with this information’ at the forefront of their mind. Physiological insight is rarely a disadvantage.