Variability in Pediatric Ideal Body Weight Calculation: Implications for Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome*
Variability in Pediatric Ideal Body Weight Calculation: Implications for Lung-Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress Syndrome*
复制标题
DOI：
10.1097/pcc.0000000000001740
复制
发表时间：
2018-12-01
影响因子：
4.1
通讯作者：
Matthay, Michael A.
中科院分区：
文献类型：
--
作者：
Ward, Shan L.;Quinn, Carson M.;Matthay, Michael A.
目的：目前还没有确定儿童理想体重的金标准。我们的目的是比较理想体重计算的四种方法，并确定方法之间的一致性水平和测量方差对机械通气儿科急性呼吸窘迫综合征潮气量的影响。设计：对四项多中心儿科急性呼吸窘迫综合征研究进行事后分析。设置：26个学术PICU。患者：589例患者。干预措施：测量方法和主要结果：采用四种常用方法计算理想体重：美国国家卫生统计中心、McLaren、摩尔和体重指数，并从三个方面进行比较：1）确定每种方法都能成功计算理想体重的队列比例; 2）通过Bland-Altman分析比较理想体重方法之间的一致性水平;以及3）评价当规定6 mL/kg理想体重时潮气量的差异。我们先验地将更好的方法定义为可以计算大多数受试者的理想体重，与其他方法具有良好的一致性，并导致较低的潮气量。只有55%的人可以用所有四种方法测量理想的体重。美国国家卫生统计中心、McLaren和摩尔方法可以计算出大于或等于90%的理想体重，而体重指数方法的成功率仅为61%，因为没有在2岁以下儿童中进行体重指数验证。在将每种方法与其他方法进行比较时，存在很大的差异，特别是在大于或等于10岁的儿童中。摩尔法和体重指数法之间的差异最大，一些受试者的理想体重差异大于或等于10 kg。McLaren方法与所有其他方法有最好的协议，并产生了类似的规定潮气量在2- 10岁的孩子和较低的潮气量大于或等于10岁。结论：有很大的变化，在计算理想的体重之间的四个常用的方法，特别是在青少年。由于不同的理想体重可能会导致儿科急性呼吸窘迫综合征护理的差异，需要一个标准的方法来测量理想体重。我们推荐McLaren方法计算小儿急性呼吸窘迫综合征患儿的理想体重，直到金标准方法得到验证。
Objectives: No gold standard for ideal body weight determination in children exists. We aimed to compare four methods of ideal body weight calculation and determine level of agreement between methods and impact of measurement variance on tidal volumes prescribed in mechanically ventilated pediatric acute respiratory distress syndrome.Design: Post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies.Setting: Twenty-six academic PICUs.Patients: Five hundred eighty-nine patients.Interventions: None.Measurements and Main Results: Ideal body weight was calculated by four common methods: National Center for Health Statistics, McLaren, Moore, and body mass index, and compared in three ways: 1) determine the proportion of the cohort for which each method could successfully calculate ideal body weight; 2) compare the level of agreement between the ideal body weight methods by Bland-Altman analysis; and 3) evaluate the difference in tidal volume when 6 mL/kg ideal body weight was prescribed. We a priori defined the better method to be one that could calculate ideal body weight in most subjects, had good agreement with other methods, and led to a lower tidal volume. Only 55% could have ideal body weight measured by all four methods. National Center for Health Statistics, McLaren, and Moore methods could calculate ideal body weight in greater than or equal to 90%, whereas body mass index method was successful in only 61% because of no body mass index validation in less than 2-year-olds. In comparing each method to the others, there was great variance, particularly in greater than or equal to 10-year-olds. This variance was greatest between Moore and body mass index methods with greater than or equal to 10 kg difference in ideal body weight in some subjects. The McLaren method had the best agreement with all other methods, and yielded similar prescribed tidal volume in 2-to 10-year-olds and lower tidal volume in greater than or equal to 10 years old.Conclusions: There is substantial variation in calculated ideal body weight among four commonly used methods, particularly in adolescents. Since varying ideal body weight may lead to discrepancies in pediatric acute respiratory distress syndrome care, a standard approach to ideal body weight measurement is needed. We recommend the McLaren method to calculate ideal body weight in children with pediatric acute respiratory distress syndrome until a gold standard method is validated.