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Ventilation Intensity and Prognosis in Pediatric Oncology: Mechanical Power, Compliance, and Mortality Risk

Bruno Sanchez Camargo1, Gabriela Maria Virgílio Dias Santos1, Orlei Ribeiro de Araujo1

  • 1Pediatric Intensive Care-Support Group for Adolescents and Children with Cancer (GRAACC), Institute of Pediatric Oncology/Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

Pediatric Pulmonology
|June 21, 2026
PubMed

Insights

Elevated mechanical power (MP) in mechanically ventilated children with cancer significantly increases mortality risk and reduces ventilator-free days (VFD). Optimizing ventilation strategies is crucial for improving outcomes in this vulnerable patient group.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Oncology

Background:

  • Mechanical power (MP) and dynamic compliance (Cdyn) are critical factors in ventilator-induced lung injury (VILI) and patient mortality.
  • Understanding their impact is vital, especially in vulnerable pediatric populations like cancer patients.

Purpose of the Study:

  • To identify variables associated with MP and Cdyn in critically ill children with cancer.
  • To evaluate the impact of MP and Cdyn on mortality and ventilator-free days (VFD).

Main Methods:

  • Prospective observational study of 57 pediatric cancer patients.
  • Multivariate logistic regression and competing risk models were used to analyze data.
  • Receiver operating characteristic (ROC) and Kaplan-Meier analyses were performed.

Main Results:

  • MP/Cdyn was an independent predictor of mortality (OR: 5.44) and associated with organ dysfunction and low platelet counts.
  • An MP/Cdyn cutoff of 1.11 J·cmH2O/min·mL predicted ICU mortality with 76% AUC.
  • Higher MP was linked to fewer VFD (SHR: 0.17), while VFD also correlated with Cdyn/PBW, PCO2, lung ultrasound findings, and oxygen saturation index.

Conclusions:

  • Elevated mechanical power is strongly associated with reduced ICU survival in critically ill children with cancer.
  • Higher MP is linked to fewer ventilator-free days, underscoring its prognostic significance.
  • Ventilation strategies play a crucial role in the outcomes of this patient population.
Abstract

Keywords:
childcriticall illnessdeterminantshospitalmechanical ventilationmortalityoncology service

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