Universidad del Desarrollo

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Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study
(2022)
Anoopindar K. Bhalla
;
Margaret J. Klein
;
Vicent Modesto I Alapont
;
Guillaume Emeriaud
;
Martin C. J. Kneyber
<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>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).</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective analysis of a prospective observational international cohort study.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), <jats:italic>p</jats:italic> = 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<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> OR 1.12 [0.94, 1.32], <jats:italic>p</jats:italic> = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> OR 1.22 [1.01, 1.46], <jats:italic>p</jats:italic> = 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<jats:sup>−1</jats:sup>·Kg<jats:sup>−1</jats:sup> SHR 0.89 (0.82, 0.96), <jats:italic>p</jats:italic> = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO<jats:sub>2</jats:sub> than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> <jats:p><jats:bold>Take Home Message</jats:bold>: 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.</jats:p> </jats:sec>
7Scopus© Citations 23
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Quality and capacity indicators for hospitalized pediatric oncology patients with critical illness: A modified delphi consensus
(2020)
Anita V. Arias
;
Marcela Garza
;
Srinivas Murthy
;
Adolfo Cardenas
;
Franco Diaz
5Scopus© Citations 18
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Mapping regional strain in anesthetised healthy subjects during spontaneous ventilation
(2019)
Pablo Cruces
;
Benjamín Erranz
;
Felipe Lillo
;
Mauricio A Sarabia-Vallejos
;
Pablo Iturrieta
<jats:sec><jats:title>Introduction</jats:title><jats:p>Breathing produces a phenomenon of cyclic deformation throughout life. Biomechanically, deformation of the lung is measured as strain. Regional strain recently started to be recognised as a tool in the study of lung pathophysiology, but regional lung strain has not been studied in healthy subjects breathing spontaneously without voluntary or pharmacological control of ventilation. Our aim is to generate three-dimensional (3D) regional strain and heterogeneity maps of healthy rat lungs and describe their changes over time.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Micro-CT and image-based biomechanical analysis by finite element approach were carried out in six anaesthetised rats under spontaneous breathing in two different states, at the beginning of the experiment and after 3 hours of observation. 3D regional strain maps were constructed and divided into 10 isovolumetric region-of-interest (ROI) in three directions (apex to base, dorsal to ventral and costal to mediastinal), allowing to regionally analyse the volumetric strain, the strain progression and the strain heterogeneity. To describe in depth these parameters, and systematise their report, we defined <jats:italic>regional strain heterogeneity index</jats:italic> [1+strain SD ROI(x)]/[1+strain mean ROI(x)] and <jats:italic>regional strain progression index</jats:italic> [ROI(x)−mean of final strain/ROI(x)−mean of initial strain].</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We were able to generate 3D regional strain maps of the lung in subjects without respiratory support, showing significant differences among the three analysed axes. We observed a significantly lower regional volumetric strain in the apex sector compared with the base, with no significant anatomical systematic differences in the other directions. This heterogeneity could not be identified with physiological or standard CT methods. There was no progression of the analysed regional volumetric strain when the two time-points were compared.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>It is possible to map the regional volumetric strain in the lung for healthy subjects during spontaneous breathing. Regional strain heterogeneity and changes over time can be measured using a CT image-based numerical analysis applying a finite element approach. These results support that healthy lung might have significant regional strain and its spatial distribution is highly heterogeneous. This protocol for CT image acquisition and analysis could be a useful tool for helping to understand the mechanobiology of the lung in many diseases.</jats:p></jats:sec>
Scopus© Citations 11 3

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