Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study.

Data de publicació: 03/01/2022 Data Ahead of Print: 03/01/2022

Autors de IIS La Fe

Vicent Modesto Alapont

Autor

Autors aliens a IIS La Fe

Bhalla AK
Klein MJ
Emeriaud G
Kneyber MCJ
Medina A
Cruces P
Diaz F
Takeuchi M
Maddux AB
Mourani PM
Camilo C
White BR
Yehya N
Pappachan J
Di Nardo M
Shein S
Newth C
Khemani R
Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Abstract

BACKGROUND: Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS). METHODS: Retrospective analysis of a prospective observational international cohort study. RESULTS: There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure-positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min(-1)·Kg(-1) Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), p = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min(-1)·Kg(-1) OR 1.12 [0.94, 1.32], p = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min(-1)·Kg(-1) OR 1.22 [1.01, 1.46], p = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min(-1)·Kg(-1) SHR 0.89 (0.82, 0.96), p = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO(2) than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD. CONCLUSIONS: Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation. TAKE HOME MESSAGE: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.

Dades de la publicació

ISSN/ISSNe:: 1364-8535, 1466-609X
Tipus:: Article
Pàgines:: 2-2
DOI:: 10.1186/s13054-021-03853-6
PubMed:: 34980228
Factor d'Impacte:: 3,218 SCImago ℠
Quartil:: Q1 SCImago ℠

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Filiacions

Bhalla AK:: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.

Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Klein MJ:: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
Modesto I Alapont V:: University and Polytechnic Hospital La Fe Valencia, Valencia, Spain
Emeriaud G:: Pediatric Intensive Care Unit, CHU Sainte-Justine, Department of Pediatrics, Université de Montréal, Montreal, Canada
Medina A:: Hospital Universitario Central de Asturias, Oviedo, Spain
Cruces P:: Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile

Departamento de Pediatría, Unidad de Paciente Crítico Pediátrico, Hospital El Carmen de Maipú, Santiago, Chile
Diaz F:: Instituto de Ciencias e Innovación ed Medicina (ICIM), Universidad del Desarrollo, Santiago, Chile

Hospital Clínico La Florida, Santiago, Chile
Takeuchi M:: Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
Maddux AB:: Pediatric Critical Care, University of Colorado School of Medicine, Aurora, CO, USA

Children's Hospital Colorado, Aurora, CO, USA
Mourani PM:: Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Camilo C:: PICU, Hospital de Santa Maria - CHULN, Lisbon, Portugal
White BR:: Penn State Health Children's Hospital, Hershey, PA, USA
Yehya N:: Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
Pappachan J:: Paediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK

Faculty of Medicine, University of Southampton, Southampton, UK
Di Nardo M:: Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
Shein S:: Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
Newth C:: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA

Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Khemani R:: Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA

Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA