Artículo
Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study
Fecha
2022-12Registro en:
Critical Care Volume 26, Issue 1 December 2022 Article number 2
13648535
10.1186/s13054-021-03853-6
Autor
Bhalla, Anoopindar K.
Klein, Margaret J.
Modesto I Alapont, Vicent
Emeriaud, Guillaume
Kneyber, Martin C. J.
Medina, Alberto
Cruces, Pablo
Diaz, Franco
Takeuchi, Muneyuki
Maddux, Aline B.
Mourani, Peter M.
Camilo, Cristina
White, Benjamin R.
Yehya, Nadir
Pappachan, John
Di Nardo, Matteo
Shein, Steven
Newth, Christopher
Khemani, Robinder
Poterala, Rossana
Fernandez, Analia
Vera, Antonio Ávila
Vidal, Nilda Agueda
Rosemary, Deheza
Turon, Gonzalo
Monjes, Cecilia
Serrate, Alejandro Siaba
Iolster, Thomas
Torres, Silvio
Castellani, Pablo
Giampieri, Martin
Pedraza, Claudia
Landry, Luis Martin
Althabe, Maria
Fortini, Yanina Vanesa
Erickson, Simon
Barr, Samantha
Shea, Sara
Butt, Warwick
Delzoppo, Carmel
Pintimalla, Alyssa
León, Alejandro Fabio Martínez
Rivera, Gustavo Alfredo Guzmán
Jouvet, Philippe
Dumitrascu, Mariana
French, Mary Ellen
Caro I, Daniel
Acuna, Carlos
Núnez, María José
Chen, Yang
Alarcón, Yurika Paola López
Izquierdo, Ledys María
Piñeres Olave, Byron Enrique
Hoyos, Pablo Vásquez
Bourgoin, Pierre
Baudin, Florent
Briassoulis, George
Ilia, Stavroula
Chiusolo, Fabrizio
Shime, Nobuaki
Institución
Resumen
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 PCO2 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. © 2021, The Author(s).