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Tasker RC. Editor's Choice Articles for September. Pediatr Crit Care Med 2024; 25:779-783. [PMID: 39240664 DOI: 10.1097/pcc.0000000000003597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Affiliation(s)
- Robert C Tasker
- orcid.org/0000-0003-3647-8113
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Selwyn College, Cambridge University, Cambridge, United Kingdom
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Fernández-Sarmiento J, Bejarano-Quintero AM, Tibaduiza JD, Moreno-Medina K, Pardo R, Mejía LM, Junco JL, Rojas J, Peña O, Martínez Y, Izquierdo L, Guzmán MC, Vásquez-Hoyos P, Molano M, Gallon C, Bonilla C, Fernández-Palacio MC, Merino V, Bernal C, Fernández-Sarta JP, Hernandez E, Alvarez I, Tobo JC, Beltrán MC, Ortiz J, Botia L, Fernández-Rengifo JM, Del Pilar Pereira-Ospina R, Blundell A, Nieto A, Duque-Arango C. 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. Pediatr Crit Care Med 2024; 25:848-857. [PMID: 38668099 DOI: 10.1097/pcc.0000000000003528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
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.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Ana María Bejarano-Quintero
- Department of Critical Care Medicine and Pediatrics, Clínica Infantil Colsubsidio. Universidad del Rosario, Bogotá, Colombia
| | - Jose Daniel Tibaduiza
- Department of Critical Care Medicine and Pediatrics, Clinica Somer, Medellin, Colombia
| | - Karen Moreno-Medina
- Research Department, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Rosalba Pardo
- Department of Critical Care Medicine and Pediatrics, Clínica Infantil Colsubsidio, Bogotá, Colombia
| | - Luz Marina Mejía
- Department of Critical Care Medicine and Pediatrics, Instituto Roosevelt, Bogotá, Colombia
| | - Jose Luis Junco
- Department of Critical Care Medicine and Pediatrics, Instituto Roosevelt, Bogotá, Colombia
| | - Jorge Rojas
- Department of Critical Care Medicine and Pediatrics, Hospital Santa Clara, Bogotá, Colombia
| | - Oscar Peña
- Department of Critical Care Medicine and Pediatrics, Hospital Pablo Tobon, Medellin, Colombia
| | - Yomara Martínez
- Department of Critical Care Medicine and Pediatrics, Hospital San Vicente, Medellin, Colombia
| | - Ledys Izquierdo
- Department of Critical Care Medicine and Pediatrics, Hospital Militar Central, Bogotá, Colombia
| | - Maria Claudia Guzmán
- Department of Critical Care Medicine and Pediatrics, Universidad del Bosque, Bogotá, Colombia
| | - Pablo Vásquez-Hoyos
- Department of Critical Care Medicine and Pediatrics, Hospital San Jose Centro, Fundación Universitaria Ciencias de La Salud, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Milton Molano
- Department of Critical Care Medicine and Pediatrics, Hospital Universitario de Neiva, Neiva, Colombia
| | - Carlos Gallon
- Department of Critical Care Medicine and Pediatrics, Clínica General del Norte, Barranquilla, Colombia
| | - Carolina Bonilla
- Department of Critical Care Medicine and Pediatrics, Fundación Santa Fe de Bogotá and Fundación Cardioinfantil-IC, Bogotá, Colombia
| | - Maria Carolina Fernández-Palacio
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Valentina Merino
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Christian Bernal
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Juan Pablo Fernández-Sarta
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
- Department of Pediatrics, Universidad del Rosario, Bogotá, Colombia
| | - Estefanía Hernandez
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Isabela Alvarez
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Juan Camilo Tobo
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Maria Camila Beltrán
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Juanita Ortiz
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Laura Botia
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | - Jose Manuel Fernández-Rengifo
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
| | | | - Alexandra Blundell
- Research Department, California University of Science and Medicine (CUSM), School of Medicine, Colton, CA
| | - Andres Nieto
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
- Department of Pediatrics, Universidad del Rosario, Bogotá, Colombia
| | - Catalina Duque-Arango
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia
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Cruces P, Reveco S, Caviedes P, Díaz F. Respiratory System Compliance Accurately Assesses the "Baby Lung" in Pediatric Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2024; 209:890-893. [PMID: 38324072 PMCID: PMC10995576 DOI: 10.1164/rccm.202310-1890le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/06/2024] [Indexed: 02/08/2024] Open
Affiliation(s)
- Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); and
| | - Sonia Reveco
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Paola Caviedes
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); and
- Unidad de Investigación y Epidemiología Clínica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
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Cruces P, Moreno D, Reveco S, Améstica M, Araneda P, Ramirez Y, Vásquez-Hoyos P, Díaz F. Capnometry after an inspiratory breath hold, PLAT CO 2 , as a surrogate for P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ in mild to moderate pediatric acute respiratory distress syndrome: A feasibility study. Pediatr Pulmonol 2023; 58:2899-2905. [PMID: 37594148 DOI: 10.1002/ppul.26610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Accurate and reliable noninvasive methods to estimate gas exchange are necessary to guide clinical decisions to avoid frequent blood samples in children with pediatric acute respiratory distress syndrome (PARDS). We aimed to investigate the correlation and agreement between end-tidalP CO 2 ${P}_{{\mathrm{CO}}_{2}}$ measured immediately after a 3-s inspiratory-hold (PLAT CO2 ) by capnometry andP aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ measured by arterial blood gases (ABG) in PARDS. DESIGN Prospective cohort study. SETTING Seven-bed Pediatric Intensive Care Unit, Hospital El Carmen de Maipú, Chile. PATIENTS Thirteen mechanically ventilated patients aged ≤15 years old undergoing neuromuscular blockade as part of management for PARDS. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All patients were in volume-controlled ventilation mode. The regular end-tidalP CO 2 ( P ETCO 2 ) ${P}_{{\mathrm{CO}}_{2}}({P}_{{\mathrm{ETCO}}_{2}})$ (without the inspiratory hold) was registered immediately after the ABG sample. An inspiratory-hold of 3 s was performed for lung mechanics measurements, recordingP ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ in the breath following the inspiratory-hold. (PLAT CO2 ). End-tidal alveolar dead space fraction (AVDSf) was calculated as[ ( P aCO 2 - P ETCO 2 ) / P aCO 2 ] $[({P}_{{\mathrm{aCO}}_{2}}\mbox{--}{P}_{{\mathrm{ETCO}}_{2}})/{P}_{{\mathrm{aCO}}_{2}}]$ and its surrogate (S)AVDSf as[ ( PLAT CO 2 - P ETCO 2 ) / PLAT CO 2 ] $[{(}_{\mathrm{PLAT}}{\mathrm{CO}}_{2}\mbox{--}{P}_{{\mathrm{ETCO}}_{2}}){/}_{\mathrm{PLAT}}{\mathrm{CO}}_{2}]$ . Measurements ofP aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ were considered the gold standard. We performed concordance correlation coefficient (ρc), Spearman's correlation (rho), and Bland-Altmann's analysis (mean difference ± SD [limits of agreement, LoA]). Eleven patients were included, with a median (interquartile range) age of 5 (2-11) months. Tidal volume was 5.8 (5.7-6.3) mL/kg, PEEP 8 (6-8), driving pressure 10 (8-11), and plateau pressure 17 (17-19) cm H2 O. Forty-one paired measurements were analyzed.P aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ was higher thanP ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ (52 mmHg [48-54] vs. 42 mmHg [38-45], p < 0.01), and there were no significant differences with PLAT CO2 (50 mmHg [46-55], p > 0.99). The concordance correlation coefficient and Spearman's correlation betweenP aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ and PLAT CO2 were robust (ρc = 0.80 [95% confidence interval [CI]: 0.67-0.90]; and rho = 0.80, p < 0.001.), and forP ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ were weak and strong (ρc = 0.27 [95% CI: 0.15-0.38]; and rho = 0.63, p < 0.01). The bias between PLAT CO2 andP aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ was -0.4 ± 3.5 mmHg (LoA -7.2 to 6.4), and betweenP ETCO 2 ${P}_{{\mathrm{ETCO}}_{2}}$ andP aCO 2 ${P}_{{\mathrm{aCO}}_{2}}$ was -8.5 ± 4.1 mmHg (LoA -16.6 to -0.5). The correlation between AVDSf and (S)AVDSf was moderate (rho = 0.55, p < 0.01), and the mean difference was -0.5 ± 5.6% (LoA -11.5 to 10.5). CONCLUSION This pilot study showed the feasibility of measuring end-tidal CO2 after a 3-s end-inspiratory breath hole in pediatric patients undergoing controlled ventilation for ARDS. Encouraging preliminary results warrant further study of this technique.
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Affiliation(s)
- Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Colombia
| | - Diego Moreno
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Sonia Reveco
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Marjorie Améstica
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Patricio Araneda
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Yenny Ramirez
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
| | - Pablo Vásquez-Hoyos
- Departamento de Pediatría, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
- Departamento de Pediatría, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Colombia
- Unidad de Investigación y epidemiología clínica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
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Abstract
The September 2023 issue and this year has already proven to be important for improving our understanding of pediatric acute respiratory distress syndrome (PARDS); Pediatric Critical Care Medicine (PCCM) has published 16 articles so far. Therefore, my three Editor's Choice articles this month highlight yet more PCCM material about PARDS by covering the use of noninvasive ventilation (NIV), the trajectory in cytokine profile during illness, and a new look at lung mechanics. The PCCM Connections for Readers give us the opportunity to focus on some clinical biomarkers of severity and mortality risk during critical illness.
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Affiliation(s)
- Robert C Tasker
- orcid.org/0000-0003-3647-8113
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Selwyn College, Cambridge University, Cambridge, United Kingdom
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Tasker RC. Editor's Choice Articles for July. Pediatr Crit Care Med 2023; 24:537-540. [PMID: 37409895 DOI: 10.1097/pcc.0000000000003302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
This is another excellent issue of Pediatric Critical Care Medicine (PCCM) for July; congratulations to our authors and many thanks to all reviewers. This month, my Editor's Choice articles cover three topics: clinical pathophysiology in pediatric patients supported using extracorporeal membrane oxygenation (ECMO); unplanned extubation of endotracheal tubes in pediatric cardiac ICU (CICU) patients; and sepsis biomarkers in the low-middle income (LMIC) resource setting. The PCCM Connections for Readers focuses on a novel pediatric theme in lung mechanics physiology, i.e., mechanical power in pediatric acute respiratory distress syndrome (PARDS).
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Affiliation(s)
- Robert C Tasker
- orcid.org/0000-0003-3647-8113
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
- Selwyn College, Cambridge University, Cambridge, United Kingdom
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Battaglini D, Iavarone IG, Robba C, Ball L, Silva PL, Rocco PRM. Mechanical ventilation in patients with acute respiratory distress syndrome: current status and future perspectives. Expert Rev Med Devices 2023; 20:905-917. [PMID: 37668146 DOI: 10.1080/17434440.2023.2255521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/14/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Although there has been extensive research on mechanical ventilation for acute respiratory distress syndrome (ARDS), treatment remains mainly supportive. Recent studies and new ventilatory modes have been proposed to manage patients with ARDS; however, the clinical impact of these strategies remains uncertain and not clearly supported by guidelines. The aim of this narrative review is to provide an overview and update on ventilatory management for patients with ARDS. AREAS COVERED This article reviews the literature regarding mechanical ventilation in ARDS. A comprehensive overview of the principal settings for the ventilator parameters involved is provided as well as a report on the differences between controlled and assisted ventilation. Additionally, new modes of assisted ventilation are presented and discussed. The evidence concerning rescue strategies, including recruitment maneuvers and extracorporeal membrane oxygenation support, is analyzed. PubMed, EBSCO, and the Cochrane Library were searched up until June 2023, for relevant literature. EXPERT OPINION Available evidence for mechanical ventilation in cases of ARDS suggests the use of a personalized mechanical ventilation strategy. Although promising, new modes of assisted mechanical ventilation are still under investigation and guidelines do not recommend rescue strategies as the standard of care. Further research on this topic is required.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ida Giorgia Iavarone
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Invasive Ventilatory Support in Patients With Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2023; 24:S61-S75. [PMID: 36661436 DOI: 10.1097/pcc.0000000000003159] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To provide evidence for the Second Pediatric Acute Lung Injury Consensus Conference updated recommendations and consensus statements for clinical practice and future research on invasive mechanical ventilation support of patients with pediatric acute respiratory distress syndrome (PARDS). DATA SOURCES MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION We included clinical studies of critically ill patients undergoing invasive mechanical ventilation for PARDS, January 2013 to April 2022. In addition, meta-analyses and systematic reviews focused on the adult acute respiratory distress syndrome population were included to explore new relevant concepts (e.g., mechanical power, driving pressure, etc.) still underrepresented in the contemporary pediatric literature. DATA EXTRACTION Title/abstract review, full text review, and data extraction using a standardized data collection form. DATA SYNTHESIS The Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize relevant evidence and develop recommendations, good practice statements and research statements. We identified 26 pediatric studies for inclusion and 36 meta-analyses or systematic reviews in adults. We generated 12 recommendations, two research statements, and five good practice statements related to modes of ventilation, tidal volume, ventilation pressures, lung-protective ventilation bundles, driving pressure, mechanical power, recruitment maneuvers, prone positioning, and high-frequency ventilation. Only one recommendation, related to use of positive end-expiratory pressure, is classified as strong, with moderate certainty of evidence. CONCLUSIONS Limited pediatric data exist to make definitive recommendations for the management of invasive mechanical ventilation for patients with PARDS. Ongoing research is needed to better understand how to guide best practices and improve outcomes for patients with PARDS requiring invasive mechanical ventilation.
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Abstract
OBJECTIVES To describe pulmonary resistance in children undergoing invasive mechanical ventilation (MV) for different causes. DESIGN A cross-sectional study. SETTING Two PICUs in the South region of Brazil. PATIENTS Children 1 month to 15 years old undergoing MV for more than 24 hours were included. We recorded ventilator variables and measured pulmonary mechanics (inspiratory and expiratory resistance, auto positive end-expiratory pressure [PEEP], and dynamic and static compliance) in the first 48 hours of MV. INTERVENTIONS Measurements of the respiratory mechanics variables during neuromuscular blockade. MEASUREMENTS AND MAIN RESULTS A total of 113 children were included, 5 months (median [interquartile range (IQR) [2.0-21.5 mo]) old, and median (IQR) weight 6.5 kg (4.5-11.0 kg), with 60% male. Median (IQR) peak inspiratory pressure (PIP) was 30 cm H 2 O (26-35 cm H 2 O), and median (IQR) PEEP was 5 cm H 2 O (5-7 cm H 2 O). The median (IQR) duration of MV was 7 days (5-9 d), and mortality was nine of 113 (8%). The median (IQR) inspiratory and expiratory resistances were 94.0 cm H 2 O/L/s (52.5-155.5 cm H 2 O/L/s) and 117 cm H 2 O/L/s (71-162 cm H 2 O/L/s), with negative association with weight and age (Spearman -0.850). When we assess weight, in smaller children (< 10 kg) had increased pulmonary resistance, with mean values over 100 mH 2 O/L/s, which were higher than larger children ( p < 0.001). CONCLUSIONS Increased pulmonary resistance is prevalent in the pediatric population undergoing invasive MV. Especially in children less than 1 year old, this variable should be considered when defining a ventilatory strategy.
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Buratti CR, Piva J, Jouvet P. Peak Inspiratory Pressure to Estimate Plateau Pressure in Pressure Controlled Modes: Be Aware of Age and Disease. Pediatr Crit Care Med 2022; 23:225-226. [PMID: 35238844 DOI: 10.1097/pcc.0000000000002896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Cecília Rotava Buratti
- Pediatric Intensive Care, Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada
| | - Jefferson Piva
- Pediatric Intensive Care, Department of Pediatrics, Hospital de Clínicas de Porto Alegre, Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Philippe Jouvet
- Pediatric Intensive Care, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada
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Khemani RG. Should We Embrace Mechanical Power to Understand the Risk of Ventilator-Induced Lung Injury in Children? Pediatr Crit Care Med 2022; 23:71-74. [PMID: 34989714 PMCID: PMC8851678 DOI: 10.1097/pcc.0000000000002844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Robinder G Khemani
- Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
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Driving Pressure and Mechanical Power: The Return of Physiology in Pediatric Mechanical Ventilation. Pediatr Crit Care Med 2021; 22:927-929. [PMID: 34605787 DOI: 10.1097/pcc.0000000000002829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Editor's Choice Articles for October. Pediatr Crit Care Med 2021; 22:857-858. [PMID: 34605785 DOI: 10.1097/pcc.0000000000002839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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