A 12-year-old child is receiving mechanical ventilation after a skateboard accident. What should the neonatal/pediatric specialist increase to improve oxygenation?

To enhance oxygenation in a mechanically ventilated child, increasing the PEEP, or positive end-expiratory pressure, can be particularly effective. PEEP helps to recruit collapsed alveoli by preventing the full exhalation of air from the lungs, thereby increasing the functional residual capacity (FRC). This recruitment of more lung units allows for better gas exchange and effective oxygenation, especially in cases where the child may have experienced lung injury from the skateboard accident.

PEEP improves oxygenation by maintaining pressure in the lungs at the end of expiration, thereby preventing atelectasis and allowing for increased surface area for oxygen diffusion. In situations of reduced lung compliance—often seen after traumatic events—adjusting the PEEP can significantly enhance oxygen delivery to the bloodstream.

Other options like tidal volume and FiO2 also play roles in oxygenation but may not be as directly beneficial if the underlying issue is related to collapsed lung units or poor ventilation-perfusion matching. Increasing tidal volume may lead to overinflation and is often limited by lung compliance, while increasing FiO2 is useful when hypoxemia is severe, but optimizing the recruitment of lung units through PEEP provides a more structural approach to improving overall oxygenation in this scenario.