Driving Pressure Is Associated With Outcome in Pediatric Acute Respiratory Failure.
Driving Pressure Is Associated With Outcome in Pediatric Acute Respiratory Failure.
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DOI：
10.1097/pcc.0000000000002848
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Kneyber MCJ
中科院分区：
文献类型：
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作者：
van Schelven P;Koopman AA;Burgerhof JGM;Markhorst DG;Blokpoel RGT;Kneyber MCJ
驱动压（DP）[潮气量与呼吸系统顺应性的比值]与急性呼吸窘迫综合征（ARDS）的死亡率相关。我们试图评估这种关联是否可以在危重儿童中确定。我们通过对前瞻性收集的生理数据进行二次分析，研究了机械通气第1天的DP与第28天无呼吸机天数（VFD-28）之间的相关性。大学内外科医院儿科加护病房。年龄小于18岁的儿童（根据儿科机械通气共识会议临床表型定义分层），无自主呼吸证据。分析了222例中位年龄为11（2 - 51）个月的患者的数据。65例（29.3%）患者符合PEMVECC限制性肺疾病标准，78例（35.1%）符合混合性肺疾病标准，10.4%的患者患有ARDS。根据潮气量（Vt）与呼吸系统顺应性（Crs）的比值[Vt/Cr]计算的整个队列的DP为16（12 - 21）cmH 2 O，并与静态气道压力梯度（平台压减去呼气末正压[PEEP]）相关（rs. 797，p <. 001）。Bland-Altman分析表明，动态压差（吸气峰压减去PEEP）高估了驱动压（一致性水平为-2.295至7.268）。通过双重分层程序重新匹配队列（获得一个变量的平均水平匹配但另一个排序变量的平均水平不同的患者亚组）显示，在因直接肺部适应症而通气的患者中，VFD-28随着驱动压力的增加而降低。竞争风险回归分析显示，在调整PRISM III-24小时评分、直接肺部指征损伤和氧合指数后，增加驾驶压力仍然与拔管时间增加独立相关（p < 0.001）。较高的驱动压力与机械通气儿童拔管时间增加独立相关。应谨慎解释驱动压力的动态评估。
Driving pressure (DP) [ratio of tidal volume over respiratory system compliance] is associated with mortality in acute respiratory distress syndrome (ARDS). We sought to evaluate if such association could be identified in critically ill children. We studied the association between DP on day 1 of mechanical ventilation and ventilator-free days at day 28 (VFD-28) through secondary analyses of prospectively collected physiology data. Medical-surgical university hospital pediatric intensive care unit. Children younger than 18 years (stratified by Pediatric Mechanical Ventilation Consensus Conference clinical phenotype definitions) without evidence of spontaneous respiration. Inspiratory hold maneuvers Data of 222 patients with median age 11 (2 – 51) months was analyzed. Sixty-five (29.3%) patients met PEMVECC criteria for restrictive and 78 (35.1%) for mixed lung disease, and 10.4% of all patients had ARDS. DP calculated by the ratio of tidal volume (Vt) over respiratory system compliance (Crs) [Vt/Cr] for the whole cohort was 16 (12 – 21) cmH2O and correlated with the static airway pressure gradient (plateau pressure minus positive end-expiratory pressure [PEEP]) (rs .797, p < .001). Bland-Altman analysis showed that the dynamic pressure gradient (peak inspiratory pressure minus PEEP) overestimated driving pressure (levels of agreement −2.295 to 7.268). Rematching the cohort through a double stratification procedure (obtaining subgroups of patients with matched mean levels for one variable but different mean levels for another ranking variable) showed a reduction in VFD-28 with increasing driving pressure in patients ventilated for a direct pulmonary indication. Competing risk regression analysis showed that increasing driving pressure remained independently associated with increased time to extubation (p < 0.001) after adjusting for PRISM III-24hr score, presence of direct pulmonary indication jury and oxygenation index. Higher driving pressure was independently associated with increased time to extubation in mechanically ventilated children. Dynamic assessments of driving pressure should be cautiously interpreted.