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Reliability of Driving Pressure Measurement in Children Receiving Pressure Support Ventilation
Larissa Conceição Dias Lopes1, Tiago da Silva Lopes2, Mirna Marques da Fonsêca3
1Drs. Lopes and Martinez are affiliated with Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Insights
Driving pressure (ΔP) measurement is reliable in children on pressure support ventilation (PSV). This finding supports its use for monitoring pulmonary stress in pediatric patients receiving mechanical 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.
Abstract:
Background: Driving pressure (ΔP) is an important predictor of mortality in patients receiving invasive mechanical ventilation and is used to monitor pulmonary mechanical stress. However, its reliability in the pediatric population during patient-triggered ventilation is unclear. This study aimed to evaluate the intra- and inter-examiner reliability of ΔP measurement in children on pressure support ventilation (PSV) mode. Methods: This clinimetric study was conducted in a single-center, tertiary pediatric ICU. Children aged between one month and 17 years, on PSV, were enrolled between February 2022 and December 2023. ΔP measurement was performed by 2 independent evaluators with a one-minute interval using the standard formula (plateau pressure - PEEP). Plateau pressure was obtained by interrupting the flow at the end of inspiration during spontaneous breathing in PSV. Intraclass correlation coefficient (ICC) was used to assess agreement, and Bland-Altman analysis was used to evaluate average bias. Results: Data from 67 subjects, totaling 93 paired assessments, were analyzed. Reliability analysis showed high inter-examiner (A1 × B: ICC = 0.96, A2 × B: ICC = 0.97) and intra-examiner (A1 × A2: ICC = 0.97) agreement, all with P < .001. Average bias between examiners was -0.04 ± 1.16 (A1 × B), 0.02 ± 0.90 (A2 × B), and -0.06 ± 1.01 for repeated measurements by the same examiner. Conclusions: ΔP measurement in children undergoing PSV could be reliably assessed by different examiners. Further studies with larger samples are recommended to validate these findings.
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