Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study.
Critical care
Mechanical
Pediatrics
Ventilator-induced lung injury
Ventilators
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
03 01 2022
03 01 2022
Historique:
received:
29
09
2021
accepted:
01
12
2021
entrez:
4
1
2022
pubmed:
5
1
2022
medline:
21
1
2022
Statut:
epublish
Résumé
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). Retrospective analysis of a prospective observational international cohort study. 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 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. 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.
Sections du résumé
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
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.
Identifiants
pubmed: 34980228
doi: 10.1186/s13054-021-03853-6
pii: 10.1186/s13054-021-03853-6
pmc: PMC8722295
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001854
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000130
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001855
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR003167
Pays : United States
Investigateurs
Rossana Poterala
(R)
Analia Fernandez
(A)
Antonio Avila Vera
(AA)
Nilda Agueda Vidal
(NA)
Deheza Rosemary
(D)
Gonzalo Turon
(G)
Cecilia Monjes
(C)
Alejandro Siaba Serrate
(AS)
Thomas Iolster
(T)
Silvio Torres
(S)
Pablo Castellani
(P)
Martin Giampieri
(M)
Claudia Pedraza
(C)
Luis Martin Landry
(LM)
Maria Althabe
(M)
Yanina Vanesa Fortini
(YV)
Simon Erickson
(S)
Samantha Barr
(S)
Sara Shea
(S)
Warwick Butt
(W)
Carmel Delzoppo
(C)
Alyssa Pintimalla
(A)
Alejandro Fabio Martinez Leon
(AFM)
Gustavo Alfredo Guzman Rivera
(GAG)
Philippe Jouvet
(P)
Guillaume Emeriaud
(G)
Mariana Dumitrascu
(M)
Mary Ellen French
(ME)
Daniel Caro I
(D)
Carlos Acuna
(C)
Franco Diaz
(F)
Maria Jose Nunez
(MJ)
Yang Chen
(Y)
Yurika Paola Lopez Alarcon
(YPL)
Ledys Maria Izquierdo
(LM)
Byron Enrique Piñeres Olave
(BE)
Pablo Vasquez Hoyos
(PV)
Pierre Bourgoin
(P)
Florent Baudin
(F)
George Briassoulis
(G)
Stavroula Ilia
(S)
Matteo Di Nardo
(M)
Fabrizio Chiusolo
(F)
Nobuaki Shime
(N)
Shinichiro Ohshimo
(S)
Yoshiko Kida
(Y)
Michihito Kyo
(M)
Swee Fong Tang
(SF)
Chian Wern Tai
(CW)
Lucy Chai See Lum
(LCS)
Ismail Elghuwael
(I)
Carlos Gil Escobar
(CG)
Marta Sousa Moniz
(MS)
Cristina Camilo
(C)
Tarek Hazwani
(T)
Nedaa Aldairi
(N)
Ahmed Al Amoudi
(A)
Ahmad Alahmadti
(A)
Yolanda Lopez Fernandez
(YL)
Juan Ramon Valle
(JR)
Lidia Martinez
(L)
Javier Pilar Orive
(JP)
Vicent Modesto I Alapont
(V)
Marti Pons Odena
(MP)
Alberto Medina
(A)
Susana Reyes Dominguez
(SR)
Oguz Dursun
(O)
Ebru Atike Ongun
(EA)
Fulya Kamit Can
(FK)
Ayse Berna Anil
(AB)
Jon Lillie
(J)
Shane Tibby
(S)
Paul Wellman
(P)
Holly Belfield
(H)
Joe Brierley
(J)
Troy E Dominguez
(TE)
Eugenia Abaleke
(E)
Yael Feinstein
(Y)
James Weitz
(J)
Peter-Marc Fortune
(PM)
Gayathri Subramanian
(G)
Claire Jennings
(C)
David Inwald
(D)
Calandra Feather
(C)
Rachel Agbeko
(R)
Angela Lawton-Woodhall
(A)
Karen McIntyre
(K)
Ryan Nofziger
(R)
Samir Latifi
(S)
Heather Anthony
(H)
Ron Sanders
(R)
Glenda Hefley
(G)
Manpreet Virk
(M)
Nancy Jaimon
(N)
Robinder Khemani
(R)
Christopher Newth
(C)
Anoopindar Bhalla
(A)
Jeni Kwok
(J)
Rica Morzov
(R)
Sidharth Mahapatra
(S)
Edward Truemper
(E)
Lucinda Kustka
(L)
Sholeen T Nett
(ST)
Marcy Singleton
(M)
J Dean Jarvis
(JD)
Nadir Yehya
(N)
Natalie Napolitano
(N)
Marie Murphy
(M)
Laurie Ronan
(L)
Ryan Morgan
(R)
Sherri Kubis
(S)
Elizabeth Broden
(E)
Rainer Gedeit
(R)
Kathy Murkowski
(K)
Katherine Woods
(K)
Mary Kasch
(M)
Yong Y Han
(YY)
Jeremy T Affolter
(JT)
Kelly S Tieves
(KS)
Amber Hughes-Schalk
(A)
Ranjit S Chima
(RS)
Kelli Krallman
(K)
Erin Stoneman
(E)
Laura Benken
(L)
Toni Yunger
(T)
James Schneider
(J)
Todd Sweberg
(T)
Aaron Kessel
(A)
Christopher L Carroll
(CL)
James Santanelli
(J)
Kate G Ackerman
(KG)
Melissa Cullimore
(M)
Courtney Rowan
(C)
Melissa Bales
(M)
W Keith Dockery
(WK)
Shirin Jafari-Namin
(S)
Dana Barry
(D)
Keary Jane't
(K)
Shira Gertz
(S)
Bria Coates
(B)
Lawren Wellisch
(L)
Kiona Allen
(K)
Avani Shukla
(A)
Neal J Thomas
(NJ)
Debbie Spear
(D)
Steven L Shein
(SL)
Margaret M Parker
(MM)
Daniel Sloniewsky
(D)
Christine Allen
(C)
Amy Harrell
(A)
Natalie Cvijanovich
(N)
Katri Typpo
(K)
Connor Kelley
(C)
Caroline King
(C)
Anil Sapru
(A)
Anna Ratiu
(A)
Neda Ashtari
(N)
Asumthia S Jeyapalan
(AS)
Alvaro Coronado-Munoz
(A)
Janet Hume
(J)
Dan Nerheim
(D)
Lincoln Smith
(L)
Silvia Hartmann
(S)
Erin Sullivan
(E)
Courtney Merritt
(C)
Awni Al-Subu
(A)
Andrea Blom
(A)
Deyin D Hsing
(DD)
Steve Pon
(S)
Jim Brian Estil
(JB)
Richa Gautam
(R)
John S Giuliano
(JS)
Joana Tala
(J)
Informations de copyright
© 2021. The Author(s).
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