Related Experiment Video
Updated: Jun 27, 2025
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome:
Jaime Fernández-Sarmiento1, Ana María Bejarano-Quintero2, Jose Daniel Tibaduiza3
1Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia.
Insights
High driving pressure (DP) in pediatric acute respiratory distress syndrome (PARDS) patients receiving mechanical ventilation (MV) is linked to increased mortality. Monitoring DP levels, especially above 15 cm H2O at 72 hours, is crucial for better outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- High driving pressure (DP) is a known risk factor for adverse outcomes in pediatric acute respiratory distress syndrome (PARDS).
- Understanding the temporal relationship between DP and mortality is essential for optimizing ventilation strategies.
Purpose of the Study:
- To assess the time course of DP levels at 24, 48, and 72 hours after initiating mechanical ventilation (MV) in children with PARDS.
- To determine the association between DP levels and 28-day mortality in this patient population.
Main Methods:
- A multicenter, prospective study involving 184 intubated children with moderate to severe PARDS across 12 tertiary care PICUs in Colombia.
- Data on driving pressure, tidal volume, respiratory system compliance, and 28-day mortality were collected.
- Statistical analyses were performed to evaluate the association between DP and mortality, controlling for relevant variables.
Main Results:
- A DP greater than 15 cm H2O at 72 hours post-MV initiation was significantly associated with increased odds of 28-day mortality (OR 2.5).
- This elevated DP at 72 hours also correlated with a longer duration of mechanical ventilation.
- While plateau pressure differed between survivors and non-survivors early on, DP > 15 cm H2O at 72 hours emerged as a key predictor of mortality (AUC 0.83).
Conclusions:
- A driving pressure exceeding 15 cm H2O at 72 hours of mechanical ventilation is a significant predictor of 28-day mortality in children with PARDS.
- Continuous monitoring of DP during protective ventilation strategies is recommended to improve patient outcomes.
- These findings underscore the importance of managing DP in pediatric mechanical ventilation.
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.
Related Concept Videos
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include: