Oxygenation Defects, Ventilatory Ratio, and Mechanical Power During Severe Pediatric Acute Respiratory Distress Syndrome: Longitudinal Time Sequence Analyses in a Single-Center Retrospective Cohort*
Oxygenation Defects, Ventilatory Ratio, and Mechanical Power During Severe Pediatric Acute Respiratory Distress Syndrome: Longitudinal Time Sequence Analyses in a Single-Center Retrospective Cohort*
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DOI：
10.1097/pcc.0000000000002822
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发表时间：
2022-01-01
影响因子：
4.1
通讯作者：
Sauthier, Michael
中科院分区：
文献类型：
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作者：
Proulx, Francois;Emeriaud, Guillaume;Sauthier, Michael
目的：我们对小儿急性呼吸窘迫综合征的理解是基于间歇性、连续性呼吸数据的研究信息。我们分析了一个高分辨率的纵向数据集，该数据集包括低氧血症严重程度、肺力学指标、呼吸比和机械功率，并研究了与儿童急性呼吸窘迫综合征发病后生存率的相关性。设计：单中心回顾性队列研究，2013-2018年。单位：三级外科/内科PICU。患者：根据儿科急性肺损伤共识会议标准确定的76例重度儿科急性呼吸窘迫综合征病例。干预措施：无。测量和主要结果：高分辨率数据库包括诊断小儿急性呼吸窘迫综合征后长达14天或直至拔管或死亡（n = 26）的连续监测呼吸数据（0.03 Hz）。在常规机械通气期间的12，128小时数据中，我们使用广义估计方程来比较各组，考虑任何时间效应。我们确定了生存率与Δ压（吸气峰压减去呼气末正压; p = 0.028）改善速度更快之间的相关性。非存活率与较高的每日儿科逻辑器官功能障碍-2评分（p = 0.005）和更严重的低氧血症指标（p = 0.005）相关。死亡率还与以下呼吸/肺部指标相关（平均差异[95% CI]）：呼气末正压水平（+2.0 cm H2O [0.8-3.2 cm H2O]; p = 0.001），峰值吸气压水平（+3.0 cm H2O [0.5-5.5 cm H2O]; p = 0.022），呼吸频率（z评分+2.2 [0.9-3.6]; p = 0.003]、屈光比（+0.41 [0.28-0.55]; p = 0.0001]和机械功率（+5焦耳/分钟[1-10焦耳/分钟]; p = 0.013）。基于广义线性混合模型，在校正正常呼吸频率、年龄和每日儿科逻辑器官功能障碍-2评分（+3焦耳/呼吸[1-6焦耳/呼吸]; p = 0.009）后，机械功率仍与死亡率相关。结论：严重小儿急性呼吸窘迫综合征后的死亡率与器官功能障碍、氧合缺陷和肺指标（包括死腔和理论机械能负荷）的严重程度相关。
OBJECTIVES: Our understanding of pediatric acute respiratory distress syndrome is based on information from studies reporting intermittent, serial respiratory data. We have analyzed a high-resolution, longitudinal dataset that incorporates measures of hypoxemia severity, metrics of lung mechanics, ventilatory ratio, and mechanical power and examined associations with survival after the onset of pediatric acute respiratory distress syndrome. DESIGN: Single-center retrospective cohort, 2013-2018. SETTING: Tertiary surgical/medical PICU. PATIENTS: Seventy-six cases of severe pediatric acute respiratory distress syndrome, determined according to the Pediatric Acute Lung Injury Consensus Conference criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The high-resolution database included continuous monitoring of ventilatory data (0.03 Hz) for up to 14 days after the diagnosis of pediatric acute respiratory distress syndrome or until extubation or death (n = 26). In the 12,128 hours of data during conventional mechanical ventilation, we used generalized estimating equations to compare groups, accounting for any effect of time. We identified an association between survival and faster rate of improvement in delta pressure (peak inspiratory pressure minus positive end-expiratory pressure; p = 0.028). Nonsurvival was associated with higher daily Pediatric Logistic Organ Dysfunction-2 scores (p = 0.005) and more severe hypoxemia metrics (p = 0.005). Mortality was also associated with the following respiratory/pulmonary metrics (mean difference [95% CI]): positive end-expiratory pressure level (+2.0 cm H2O [0.8-3.2 cm H2O]; p = 0.001), peak inspiratory pressure level (+3.0 cm H2O [0.5-5.5 cm H2O]; p = 0.022), respiratory rate (z scores +2.2 [0.9-3.6]; p = 0.003], ventilatory ratio (+0.41 [0.28-0.55]; p = 0.0001], and mechanical power (+5 Joules/min [1-10 Joules/min]; p = 0.013). Based on generalized linear mixed modeling, mechanical power remained associated with mortality after adjustment for normal respiratory rate, age, and daily Pediatric Logistic Organ Dysfunction-2 score (+3 Joules/breath [1-6 Joules/breath]; p = 0.009). CONCLUSIONS: Mortality after severe pediatric acute respiratory distress syndrome is associated with the severity of organ dysfunction, oxygenation defects, and pulmonary metrics including dead space and theoretical mechanical energy load.