Portal de Periódicos da CAPES

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

2022; BioMed Central; Volume: 26; Issue: 1 Linguagem: Inglês

10.1186/s13054-021-03853-6

1466-609X

Anoopindar Bhalla, Margaret J. Klein, Vicent Modesto i Alapont, Guillaume Émériaud, Martin C. J. Kneyber, Alberto Medina, Pablo Cruces, Franco Díaz, Muneyuki Takeuchi, Aline B. Maddux, Peter M. Mourani, Cristina Camilo, Benjamin R. White, Nadir Yehya, John Pappachan, Matteo Di Nardo, Steven L. Shein, Christopher J. L. Newth, Robinder G. Khemani, Rossana Poterala, Analía Fernández, Antonio Ávila Vera, Nilda Águeda Vidal, Deheza Rosemary, Gonzalo Turón, Cecilia Monjes, Alejandro Siaba Serrate, Thomas Iölster, Silvio Torres, Pablo Castellani, Martin Giampieri, Claudia Pedraza, Luis M. Landry, María Althabe, Yanina Vanesa Fortini, Simon Erickson, Samantha Barr, Sara Shea, Warwick Butt, Carmel Delzoppo, Alyssa Pintimalla, Alejandro Fabio Martínez León, Gustavo Alfredo Guzman Rivera, Philippe Jouvet, Guillaume Émériaud, Mariana Dumitrascu, Mary French, Daniel Caro, Carlos Acuña, Franco Díaz, Marı́a José Núñez, Yang Chen, Yurika Paola Lopez Alarcón, Ledys Izquierdo, Byron Enrique Piñeres-Olave, Pablo Vásquez‐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 Escobar, Marta Sousa Moniz, Cristina Camilo, Tarek Hazwani, Nedaa Aldairi, Ahmed Al Amoudi, Ahmad Alahmadti, Yolanda López Fernández, Juan Ramón Valle, Lidia Martinez, J. Pilar Orive, Vicent Modesto i Alapont, M. Pons, Alberto Medina, Susana Reyes, Oğuz Dursun, Ebru Atike Ongun, Füsun Can, Ayşe Berna Anıl, Jon Lillie, Shane M. 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 A. Nofziger, Samir Latifi, Heather Anthony, Ron C. Sanders, Glenda Hefley, Manpreet Virk, Nancy Jaimon, Robinder G. Khemani, Christopher J. L. Newth, Anoopindar Bhalla, Jeni Kwok, Rica Morzov, Sidharth Mahapatra, Edward J. Truemper, Lucinda Kustka, Sholeen Nett, Marcy Singleton, Janet Jarvis, Nadir Yehya, Natalie Napolitano, Marie Murphy, Laurie Ronan, Ryan W. Morgan, Sherri Kubis, Elizabeth G. Broden, Rainer Gedeit, Kathy Murkowski, Katherine Woods, Mary Kasch, Yong Han, Jeremy T. Affolter, Kelly S. Tieves, Amber Hughes-Schalk, Ranjit S. Chima, Kelli A. Krallman, Erin Stoneman, Laura Benken, Toni Yunger, James Schneider, Todd Sweberg, Aaron Kessel, Christopher L. Carroll, James P. Santanelli, Kate G. Ackerman, Melissa L. Cullimore, Courtney M. Rowan, Melissa Bales, W. Keith Dockery, Shirin Jafari-Namin, Dana Barry, Keary Jane’t, Shira J. Gertz, Bria M. Coates, Lawren Wellisch, Kiona Y. Allen, Avani Shukla, Neal J. Thomas, Debbie Spear, Steven L. Shein, Margaret M. Parker, Daniel Sloniewsky, Christine Allen, Amy Harrell, Natalie Z. Cvijanovich, Katri Typpo, Connor M. Kelley, Caroline C. King, Anil Sapru, Anna Ratiu, Neda Ashtari, Asumthia Jeyapalan, Álvaro Coronado Muñoz, Janet R. 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,

Neonatal Respiratory Health Research

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.