Jaime Fernández-Sarmiento, Ana María Bejarano-Quintero, Jose Daniel Tibaduiza, Karen Moreno-Medina, Rosalba Pardo, Luz Marina Mejía, Jose Luis Junco, Jorge Rojas, Oscar Peña, Yomara Martínez, Ledys Izquierdo, Maria Claudia Guzmán, Pablo Vásquez-Hoyos, Milton Molano, Carlos Gallon, Carolina Bonilla, Maria Carolina Fernández-Palacio, Valentina Merino, Christian Bernal, Juan Pablo Fernández-Sarta, Estefanía Hernandez, Isabela Alvarez, Juan Camilo Tobo, Maria Camila Beltrán, Juanita Ortiz, Laura Botia, Jose Manuel Fernández-Rengifo, Rocio Del Pilar Pereira-Ospina, Alexandra Blundell, Andres Nieto, Catalina Duque-Arango
{"title":"小儿急性呼吸窘迫综合征机械通气驱动压力水平的时间过程：2018-2022年哥伦比亚一项前瞻性多中心队列研究的结果。","authors":"Jaime Fernández-Sarmiento, Ana María Bejarano-Quintero, Jose Daniel Tibaduiza, Karen Moreno-Medina, Rosalba Pardo, Luz Marina Mejía, Jose Luis Junco, Jorge Rojas, Oscar Peña, Yomara Martínez, Ledys Izquierdo, Maria Claudia Guzmán, Pablo Vásquez-Hoyos, Milton Molano, Carlos Gallon, Carolina Bonilla, Maria Carolina Fernández-Palacio, Valentina Merino, Christian Bernal, Juan Pablo Fernández-Sarta, Estefanía Hernandez, Isabela Alvarez, Juan Camilo Tobo, Maria Camila Beltrán, Juanita Ortiz, Laura Botia, Jose Manuel Fernández-Rengifo, Rocio Del Pilar Pereira-Ospina, Alexandra Blundell, Andres Nieto, Catalina Duque-Arango","doi":"10.1097/PCC.0000000000003528","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>High driving pressure (DP, ratio of tidal volume (V t ) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality.</p><p><strong>Design: </strong>Multicenter, prospective study conducted between February 2018 and December 2022.</p><p><strong>Setting: </strong>Twelve tertiary care PICUs in Colombia.</p><p><strong>Patients: </strong>One hundred eighty-four intubated children with moderate to severe PARDS.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H 2 O, p < 0.01). Of note, children with a V t less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H 2 O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H 2 O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02).</p><p><strong>Conclusions: </strong>In children with moderate to severe PARDS, a DP greater than 15 cm H 2 O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.\",\"authors\":\"Jaime Fernández-Sarmiento, Ana María Bejarano-Quintero, Jose Daniel Tibaduiza, Karen Moreno-Medina, Rosalba Pardo, Luz Marina Mejía, Jose Luis Junco, Jorge Rojas, Oscar Peña, Yomara Martínez, Ledys Izquierdo, Maria Claudia Guzmán, Pablo Vásquez-Hoyos, Milton Molano, Carlos Gallon, Carolina Bonilla, Maria Carolina Fernández-Palacio, Valentina Merino, Christian Bernal, Juan Pablo Fernández-Sarta, Estefanía Hernandez, Isabela Alvarez, Juan Camilo Tobo, Maria Camila Beltrán, Juanita Ortiz, Laura Botia, Jose Manuel Fernández-Rengifo, Rocio Del Pilar Pereira-Ospina, Alexandra Blundell, Andres Nieto, Catalina Duque-Arango\",\"doi\":\"10.1097/PCC.0000000000003528\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>High driving pressure (DP, ratio of tidal volume (V t ) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality.</p><p><strong>Design: </strong>Multicenter, prospective study conducted between February 2018 and December 2022.</p><p><strong>Setting: </strong>Twelve tertiary care PICUs in Colombia.</p><p><strong>Patients: </strong>One hundred eighty-four intubated children with moderate to severe PARDS.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H 2 O, p < 0.01). Of note, children with a V t less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H 2 O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H 2 O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02).</p><p><strong>Conclusions: </strong>In children with moderate to severe PARDS, a DP greater than 15 cm H 2 O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.</p>\",\"PeriodicalId\":19760,\"journal\":{\"name\":\"Pediatric Critical Care Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000003528\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/4/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000003528","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/4/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：高驱动压（DP，潮气量（Vt）与呼吸系统顺应性之比）是导致儿科急性呼吸窘迫综合征（PARDS）患者预后不良的风险因素。因此，我们评估了开始机械通气（MV）后 DP 水平的时间进程（即 24、48 和 72 小时）及其与 28 天死亡率的关系：2018年2月至2022年12月期间进行的多中心前瞻性研究：哥伦比亚的 12 所三级护理 PICU：干预措施：无：测量和主要结果PARDS队列的中位（四分位数间距[IQR]）年龄为11（IQR 3-24）个月。184名患者中有129名（70.2%）因肺部病因导致PARDS，184名患者中有31名（16.8%）死亡。在入院后的头 24 小时内，非存活组与存活组的高原压不同（28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H2O，P < 0.01）。值得注意的是，Vt 小于 8 mL/kg 理想体重的患儿 28 天死亡率的调整赔率（aOR [95% CI]）较低（aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02）。然而，我们未能发现 DP 水平与各时间点氧合指数之间存在关联（aOR 0.58；95% CI，0.21-1.58）。在诊断探索性分析中，我们发现 72 小时时 DP 大于 15 cm H2O 是死亡率的一个解释变量，接收器操作特征曲线下面积为 0.83（95% CI，0.74-0.89）；死亡风险也增加了，风险比为 2.5（95% CI，1.07-5.92）。72小时时DP大于15 cm H2O也与MV持续时间较长有关（10 [IQR 7-14] d vs. 7 [IQR 5-10] d; p = 0.02）：结论：在中度至重度 PARDS 患儿中，开始 MV 72 小时后 DP 大于 15 cm H2O 与 28 天死亡几率增加和 MV 持续时间延长有关。在 PARDS 保护性通气期间，DP 应被视为一个值得监测的变量。
Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.
Objectives: High driving pressure (DP, ratio of tidal volume (V t ) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality.
Design: Multicenter, prospective study conducted between February 2018 and December 2022.
Setting: Twelve tertiary care PICUs in Colombia.
Patients: One hundred eighty-four intubated children with moderate to severe PARDS.
Interventions: None.
Measurements and main results: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H 2 O, p < 0.01). Of note, children with a V t less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H 2 O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H 2 O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02).
Conclusions: In children with moderate to severe PARDS, a DP greater than 15 cm H 2 O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.
期刊介绍：
Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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