Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study.
Mechanical power in pediatric acute respiratory distress syndrome: a PARDIE study.
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DOI：
10.1186/s13054-021-03853-6
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发表时间：
2022-01-03
期刊：
影响因子：
--
通讯作者：
Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
中科院分区：
文献类型：
--
作者：
Bhalla AK;Klein MJ;Modesto I Alapont V;Emeriaud G;Kneyber MCJ;Medina A;Cruces P;Diaz F;Takeuchi M;Maddux AB;Mourani PM;Camilo C;White BR;Yehya N;Pappachan J;Di Nardo M;Shein S;Newth C;Khemani R;Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
机械功率是随时间推移传输至呼吸系统的能量的复合变量，与单个呼吸机管理组件相比，其可以更好地捕获呼吸机诱导的肺损伤风险。本研究旨在评估高机械功率机械通气管理是否与小儿急性呼吸窘迫综合征（PARDS）患儿无呼吸机天数（VFD）减少相关。前瞻性观察性国际队列研究的回顾性分析。其中包括来自55个儿科重症监护室的306名儿童。高机械功率与年龄较小、氧合指数较高、支气管肺发育不良的共病状况、潮气量较高、δ压较高（吸气峰压-呼气末正压）和呼吸频率较高相关。在控制混杂变量后，较高的机械功率与较少的28天VFD相关（每0.1 J·min-1·Kg-1亚分布风险比（SHR）0.93（0.87，0.98），p = 0.013）。在整个队列的多变量分析中，较高的机械功率与较高的重症监护室死亡率无关（每0.1 J·min-1·Kg-1 OR 1.12 [0.94，1.32]，p = 0.20）。但排除因神经系统原因死亡的儿童后，与较高的死亡率相关（每0.1 J·min-1·Kg-1 OR 1.22 [1.01，1.46]，p = 0.036）。在按年龄进行的亚组分析中，较高的机械功率与较少的28天VFD之间的关联仅在<2岁的儿童中保持（每0.1 J·min-1·Kg-1 SHR 0.89（0.82，0.96），p = 0.005）。与年龄较大的儿童相比，年龄较小的儿童采用较低的潮气量、较高的Δ压、较高的呼吸频率、较低的呼气末正压和较高的PCO2进行管理。没有单独的呼吸机管理组件介导机械功率对28天VFD的影响。较高的机械功率与PARDS儿童28天VFD较少相关。这种相关性在2岁以下的儿童中最强，他们在机械通气管理方面存在显着差异。虽然需要进一步验证，但这些数据强调了呼吸机管理与PARDS儿童的结局相关，并且可能存在从改善肺保护性通气策略中获益更高的儿童亚组。留言内容：较高的机械功率与儿科急性呼吸窘迫综合征患儿28天无呼吸机天数较少相关。这种相关性在2岁以下的儿童中最强，他们在机械通气管理方面存在显着差异。在线版本包含补充材料，可通过10.1186/s13054 - 021 - 03853 - 6获得。
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−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. 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. The online version contains supplementary material available at 10.1186/s13054-021-03853-6.
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影响因子：
8.8
作者：
Kyogoku M;Shimatani T;Hotz JC;Newth CJL;Bellani G;Takeuchi M;Khemani RG
通讯作者：
Khemani RG
DOI：
10.1164/rccm.200408-1053oc
发表时间：
2005-04-01
影响因子：
24.7
作者：
Kornecki, A;Tsuchida, S;Kavanagh, BP
通讯作者：
Kavanagh, BP
影响因子：
2.5
作者：
Smallwood, Craig D.;Walsh, Brian K.;Mehta, Nilesh M.
通讯作者：
Mehta, Nilesh M.
影响因子：
4.1
作者：
Ward, Shan L.;Quinn, Carson M.;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
影响因子：
8.8
作者：
Bhalla AK;Klein MJ;Emeriaud G;Lopez-Fernandez YM;Napolitano N;Fernandez A;Al-Subu AM;Gedeit R;Shein SL;Nofziger R;Hsing DD;Briassoulis G;Ilia S;Baudin F;Piñeres-Olave BE;Maria Izquierdo L;Lin JC;Cheifetz IM;Kneyber MCJ;Smith L;Khemani RG;Newth CJL;Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V.2. Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
通讯作者：
Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V.2. Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network