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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS

Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS

Published on: April 7, 2021

Mechanical power and normalized mechanical power in pediatric acute respiratory distress syndrome

Farhan A R Shaikh¹, Karthik N Ramaswamy², Dinesh K Chirla¹

¹Department of Pediatric Intensive Care, Rainbow Children's Hospital, Hyderabad, India.

Frontiers in Pediatrics

|February 1, 2024

Insights

Mechanical power (MP) normalization, particularly MP indexed to respiratory compliance (MP_CRS), is crucial for predicting outcomes in pediatric acute respiratory distress syndrome (pARDS). Malnutrition significantly impacts these associations.

Area of Science:

Pediatric Critical Care Medicine
Respiratory Physiology
Mechanical Ventilation

Background:

Mechanical power (MP) is a key factor in ventilator-induced lung injury.
Normalization of MP is essential to account for developmental variations in children.
Understanding MP's role in pediatric acute respiratory distress syndrome (pARDS) is critical for improving outcomes.

Purpose of the Study:

To investigate the association between mechanical energy (ME_BW), MP normalized to body weight (MP_BW), and MP normalized to respiratory compliance (MP_CRS) with pARDS severity and outcomes.
To determine the independent predictors of mortality and ventilator-free days in children with pARDS.

Main Methods:

Retrospective study of 185 children (1 month to 18 years) with pARDS on pressure-control ventilation.
Calculation of MP using Becher's equation.
Multivariable logistic regression analysis adjusted for age, pediatric organ dysfunction score, oxygenation index, and malnutrition.

Main Results:

Non-survivors had higher ME_BW, MP_BW, and MP.
ME_BW was initially associated with mortality, but this was not independent after adjusting for pARDS type.
MP_CRS at 1-4 and 24 hours was significantly correlated with ventilator-free days, unlike other MP measures.
Malnutrition was identified as a significant confounder, with MP at 24 hours showing association with mortality after adjustment.

Conclusions:

MP normalization, especially MP_CRS, is more relevant to pARDS outcomes than non-normalized MP.
Malnutrition is a critical confounding factor in assessing MP's impact, particularly in resource-limited settings.
Further research is needed to refine MP normalization strategies for pediatric populations.

Read full analysis

Abstract

Background:

Mechanical power (MP) refers to the energy transmitted over time to the respiratory system and serves as a unifying determinant of ventilator-induced lung injury. MP normalization is required to account for developmental changes in children. We sought to examine the relationship between mechanical energy (ME_BW), MP normalized to body weight (MP_BW), and MP normalized to respiratory compliance (MP_CRS) concerning the severity and outcomes of pediatric acute respiratory distress syndrome (pARDS).

Method:

In this retrospective study, children aged 1 month to 18 years diagnosed with pARDS who underwent pressure-control ventilation for at least 24 h between January 2017 and September 2020 were enrolled. We calculated MP using Becher's equation. Multivariable logistic regression analysis adjusted for age, pediatric organ dysfunction score, and oxygenation index (OI) was performed to determine the independent association of MP and its derivatives 24 h after diagnosing pARDS with 28-day mortality. The association was also studied for 28 ventilator-free days (VFD-28) and the severity of pARDS in terms of OI.

Results:

Out of 246 admitted with pARDS, 185 were eligible, with an overall mortality of 43.7%. Non-survivors exhibited higher severity of illness, as evidenced by higher values of MP, MP_BW, and ME_BW. Multivariable logistic regression analysis showed that only ME_BW but not MP, MP_BW, or MP_CRS at 24 h was independently associated with mortality [adjusted OR: 1.072 (1.002-1.147), p = 0.044]. However, after adjusting for the type of pARDS, ME_BW was not independently associated with mortality [adjusted OR: 1.061 (0.992-1.136), p = 0.085]. After adjusting for malnutrition, only MP at 24 h was found to be independently associated. Only MP_CRS at 1-4 and 24 h but not MP, MP_BW, or ME_BW at 24 h of diagnosing pARDS was significantly correlated with VFD-28.

Conclusions:

Normalization of MP is better related to outcomes and severity of pARDS than non-normalized MP. Malnutrition can be a significant confounding factor in resource-limited settings.

Keywords:

mechanical energy mechanical power mechanical ventilation normalized mechanical power pediatric acute respiratory distress syndrome ventilator-induced lung injury

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