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

In cases where a child receiving mechanical ventilation is experiencing difficulties with oxygenation, increasing the level of Positive End-Expiratory Pressure (PEEP) can be an effective intervention. PEEP helps to maintain the alveoli open at the end of expiration, which increases functional residual capacity (FRC) and helps prevent atelectasis. By improving lung recruitment, PEEP enhances overall gas exchange and allows for a better diffusion of oxygen into the bloodstream.

This approach is particularly beneficial in situations where there may be decreased lung compliance or in the context of injury, such as in a patient with trauma from a skateboard accident. By promoting better ventilation-perfusion matching and increasing the surface area available for gas exchange, adding PEEP can significantly improve oxygenation levels in these patients.

In contrast, increasing tidal volume may not be advisable if lung compliance is low, as it could lead to barotrauma or overdistension. While increasing mandatory rate or FiO2 could also address hypoxemia, they do not confer the same long-term benefits in lung mechanics and may not adequately resolve underlying issues related to lung compliance and recruitment. Thus, using PEEP is a tailored approach that directly addresses the pulmonary mechanics in this scenario.