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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
Re-evaluating early high-frequency oscillatory ventilation in moderate-to-severe pediatric ARDS: evidence from a
Feifan Jin1, Ziqing Quan1, Hongxing Dang1
1Department of PICU Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.
Insights
High-frequency oscillatory ventilation (HFOV) may increase mortality in pediatric acute respiratory distress syndrome (PARDS) compared to conventional mechanical ventilation (CMV). This study suggests CMV offers better survival outcomes for moderate-to-severe PARDS patients.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Mechanical Ventilation Strategies
Background:
- Pediatric acute respiratory distress syndrome (PARDS) has a high mortality rate in pediatric intensive care units (PICUs).
- The effectiveness of early high-frequency oscillatory ventilation (HFOV) for moderate-to-severe PARDS is debated.
- This study investigates HFOV versus conventional mechanical ventilation (CMV) in PARDS.
Purpose of the Study:
- To compare clinical outcomes between HFOV and CMV in pediatric patients with moderate-to-severe PARDS.
- To evaluate the impact of ventilation strategy on 28-day mortality and other relevant outcomes.
- To utilize genetic matching for robust comparison of ventilation groups.
Main Methods:
- Retrospective case-control study of children with moderate-to-severe PARDS in PICUs (January 2012-June 2024).
- Analysis of a 7-day landmark cohort with sustained invasive mechanical ventilation (≥7 days).
- Genetic matching in R software to balance baseline characteristics between HFOV and CMV groups; primary outcome: 28-day mortality.
Main Results:
- After matching, 53 patients were in each group with balanced characteristics.
- HFOV group showed significantly higher 28-day mortality (49.1%) compared to CMV group (28.3%, p=0.04).
- HFOV was independently associated with increased mortality (aOR=2.47); moderate PARDS patients had lower survival with HFOV (0.41 vs. 0.82, p=0.01).
Conclusions:
- Early HFOV may not benefit, and could increase mortality, in moderate-to-severe PARDS.
- Conventional mechanical ventilation (CMV) was associated with lower observed 28-day mortality.
- Further prospective studies are needed to confirm these findings regarding PARDS ventilation strategies.
Background And Aims:
Pediatric acute respiratory distress syndrome (PARDS) carries high mortality in pediatric intensive care units (PICUs). The clinical benefit of early high-frequency oscillatory ventilation (HFOV) for moderate-to-severe PARDS remains controversial. This study aimed to compare clinical outcomes between HFOV and conventional mechanical ventilation (CMV) using a robust genetic matching approach.
Methods:
In this retrospective case-control study, children with moderate-to-severe PARDS admitted to the two PICUs of Chongqing Medical University from January 2012 to June 2024 were analyzed in a pre-specified 7-day landmark cohort (sustained invasive MV ≥ 7 days). Genetic matching in R software was applied to balance baseline characteristics between HFOV and CMV groups. The primary outcome was 28-day mortality; secondary outcomes included ventilator-free days (VFD), PICU-free days (IFD), survival time, and survival rates stratified by pre-intubation PaO2/FiO2 (P/F) ratios.
Results:
After matching, 53 patients were included in each group with well-balanced baseline variables. Sensitivity (Rosenbaum bounds) and robustness (nearest-neighbor matching) analyses confirmed the stability of the matched results. The 28-day mortality was significantly higher in the HFOV group than in the CMV group (49.1% vs. 28.3%, p = 0.04), whereas VFD and IFD did not differ significantly. Logistic regression indicated that HFOV was independently associated with higher 28-day mortality [adjusted OR = 2.47 (95% CI 1.02-5.98), p = 0.04]. In stratified analysis, the 28-day survival rate for moderate PARDS (200 ≥ P/F > 100) was markedly lower with HFOV than CMV (0.41 vs. 0.82, p = 0.01).
Conclusion:
In this 7-day landmark cohort, early HFOV may not provide extra benefit in moderate-to-severe PARDS and might be associated with higher mortality, whereas CMV was linked with lower observed 28-day mortality. Further prospective studies are warranted.
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