Reliability of Driving Pressure Measurement in Children Receiving Pressure Support Ventilation

Area of Science:

• Pediatric Critical Care Medicine
• Respiratory Physiology
• Clinical Measurement Science

Background:

• Driving pressure (ΔP) is a key mortality predictor in invasive mechanical ventilation, reflecting pulmonary mechanical stress.
• Reliability of ΔP measurement in pediatric patients on patient-triggered ventilation remains uncertain.
• This study addresses the need to validate ΔP measurement in children using pressure support ventilation (PSV).

Purpose of the Study:

• To evaluate the intra- and inter-examiner reliability of driving pressure (ΔP) measurements.
• To assess the consistency of ΔP assessment in pediatric patients on pressure support ventilation (PSV).
• To provide evidence for the clinical utility of ΔP monitoring in pediatric mechanical ventilation.

Main Methods:

• Clinimetric study in a tertiary pediatric ICU involving children aged 1 month to 17 years on PSV.
• ΔP measured using the formula: plateau pressure - PEEP, with plateau pressure obtained during end-inspiratory hold.
• Intraclass correlation coefficient (ICC) and Bland-Altman analysis used to assess reliability and bias.

Main Results:

• High inter-examiner agreement (ICC = 0.96-0.97) and intra-examiner agreement (ICC = 0.97) were observed.
• All agreement metrics showed statistical significance (P < .001).
• Minimal average bias was found between examiners (-0.04 ± 1.16 to 0.02 ± 0.90) and for repeated measures (-0.06 ± 1.01).

Conclusions:

• Driving pressure (ΔP) measurement demonstrates high reliability among different examiners in pediatric patients on PSV.
• The findings support the consistent use of ΔP for monitoring mechanical ventilation in children.
• Larger sample studies are recommended to further validate these reliability results.