Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study
Journal
Critical Care
ISSN
1364-8535
Date Issued
2022
Author(s)
Anoopindar K. Bhalla
Margaret J. Klein
Vicent Modesto I Alapont
Guillaume Emeriaud
Martin C. J. Kneyber
Alberto Medina
Pablo Cruces
Muneyuki Takeuchi
Aline B. Maddux
Peter M. Mourani
Cristina Camilo
Benjamin R. White
Nadir Yehya
John Pappachan
Matteo Di Nardo
Steven Shein
Christopher Newth
Robinder Khemani
Rossana Poterala
Analia Fernandez
Antonio Avila Vera
Nilda Agueda Vidal
Deheza Rosemary
Gonzalo Turon
Cecilia Monjes
Alejandro Siaba Serrate
Thomas Iolster
Silvio Torres
Pablo Castellani
Martin Giampieri
Claudia Pedraza
Luis Martin Landry
Maria Althabe
Yanina Vanesa Fortini
Simon Erickson
Samantha Barr
Sara Shea
Warwick Butt
Carmel Delzoppo
Alyssa Pintimalla
Alejandro Fabio Martinez Leon
Gustavo Alfredo Guzman Rivera
Philippe Jouvet
Guillaume Emeriaud
Mariana Dumitrascu
Mary Ellen French
Daniel Caro I
Carlos Acuna
Franco Diaz
Maria Jose Nunez
Yang Chen
Yurika Paola Lopez Alarcon
Ledys Maria Izquierdo
Byron Enrique Piñeres Olave
Pablo Vasquez Hoyos
Pierre Bourgoin
Florent Baudin
George Briassoulis
Stavroula Ilia
Matteo Di Nardo
Fabrizio Chiusolo
Nobuaki Shime
Shinichiro Ohshimo
Yoshiko Kida
Michihito Kyo
Swee Fong Tang
Chian Wern Tai
Lucy Chai See Lum
Ismail Elghuwael
Carlos Gil Escobar
Marta Sousa Moniz
Cristina Camilo
Tarek Hazwani
Nedaa Aldairi
Ahmed Al Amoudi
Ahmad Alahmadti
Yolanda Lopez Fernandez
Juan Ramon Valle
Lidia Martinez
Javier Pilar Orive
Vicent Modesto I Alapont
Marti Pons Odena
Alberto Medina
Susana Reyes Dominguez
Oguz Dursun
Ebru Atike Ongun
Fulya Kamit Can
Ayse Berna Anil
Jon Lillie
Shane Tibby
Paul Wellman
Holly Belfield
Joe Brierley
Troy E. Dominguez
Eugenia Abaleke
Yael Feinstein
James Weitz
Peter-Marc Fortune
Gayathri Subramanian
Claire Jennings
David Inwald
Calandra Feather
Rachel Agbeko
Angela Lawton-Woodhall
Karen McIntyre
Ryan Nofziger
Samir Latifi
Heather Anthony
Ron Sanders
Glenda Hefley
Manpreet Virk
Nancy Jaimon
Robinder Khemani
Christopher Newth
Anoopindar Bhalla
Jeni Kwok
Rica Morzov
Sidharth Mahapatra
Edward Truemper
Lucinda Kustka
Sholeen T. Nett
Marcy Singleton
J. Dean Jarvis
Nadir Yehya
Natalie Napolitano
Marie Murphy
Laurie Ronan
Ryan Morgan
Sherri Kubis
Elizabeth Broden
Rainer Gedeit
Kathy Murkowski
Katherine Woods
Mary Kasch
Yong Y. Han
Jeremy T. Affolter
Kelly S. Tieves
Amber Hughes-Schalk
Ranjit S. Chima
Kelli Krallman
Erin Stoneman
Laura Benken
Toni Yunger
James Schneider
Todd Sweberg
Aaron Kessel
Christopher L. Carroll
James Santanelli
Kate G. Ackerman
Melissa Cullimore
Courtney Rowan
Melissa Bales
W. Keith Dockery
Shirin Jafari-Namin
Dana Barry
Keary Jane’t
Shira Gertz
Bria Coates
Lawren Wellisch
Kiona Allen
Avani Shukla
Neal J. Thomas
Debbie Spear
Steven L. Shein
Margaret M. Parker
Daniel Sloniewsky
Christine Allen
Amy Harrell
Natalie Cvijanovich
Katri Typpo
Connor Kelley
Caroline King
Anil Sapru
Anna Ratiu
Neda Ashtari
Asumthia S. Jeyapalan
Alvaro Coronado-Munoz
Janet Hume
Dan Nerheim
Lincoln Smith
Silvia Hartmann
Erin Sullivan
Courtney Merritt
Awni Al-Subu
Andrea Blom
Deyin D. Hsing
Steve Pon
Jim Brian Estil
Richa Gautam
John S. Giuliano
Joana Tala
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<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>
<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>
Cite this document
Bhalla, A. K., Klein, M. J., Modesto I Alapont, V., Emeriaud, G., Kneyber, M. C. J., Medina, A., Cruces, P., Diaz, F., Takeuchi, M., Maddux, A. B., Mourani, P. M., Camilo, C., White, B. R., Yehya, N., Pappachan, J., Di Nardo, M., Shein, S., Newth, C., Khemani, R., … Tala, J. (2022). Mechanical power in pediatric acute respiratory distress syndrome: A PARDIE study. Critical Care, 26(1), 2. https://doi.org/10.1186/s13054-021-03853-6
Subjects
ventilators
;
mechanical
;
ventilator-induced lung injury
;
critical care
;
pediatrics
;
adolescent
;
adult
;
child
;
child, preschool
;
cohort studies
;
humans
;
infant, newborn
;
intensive care units, pediatric
;
respiration, artificial
;
respiratory distress syndrome
;
retrospective studies
;
age distribution
;
article
;
artificial ventilation
;
breathing rate
;
carbon dioxide tension
;
child
;
cohort analysis
;
comorbidity
;
controlled study
;
delta pressure
;
female
;
hazard ratio
;
hospital mortality
;
human
;
infant
;
intensive care
;
lung dysplasia
;
major clinical study
;
male
;
mechanical power
;
observational study
;
oxygenation index
;
peak inspiratory pressure
;
pediatric acute respiratory distress syndrome
;
pediatric intensive care unit
;
positive end expiratory pressure ventilation
;
prospective study
;
respiratory distress syndrome
;
respiratory tract parameters
;
retrospective study
;
tidal volume
;
ventilator associated pneumonia
;
ventilator free day
;
adolescent
;
adult
;
adverse event
;
newborn
;
preschool child
;
respiratory distress syndrome