Lung-Protective Ventilation for Pediatric Acute Respiratory Distress Syndrome: A Nonrandomized Controlled Trial-Reference-Cited by-同舟云学术

Lung-Protective Ventilation for Pediatric Acute Respiratory Distress Syndrome: A Nonrandomized Controlled Trial

Published:2024-06-26 Issue: Volume: Page:
ISSN:0090-3493
Container-title:Critical Care Medicine
language:en
Short-container-title:

Author:

Wong Judith Ju Ming¹²,Dang Hongxing³⁴,Gan Chin Seng⁵,Phan Phuc Huu⁶,Kurosawa Hiroshi⁷,Aoki Kazunori⁷,Lee Siew Wah⁸⁹,Ong Jacqueline Soo May¹⁰,Fan Lijia¹⁰,Tai Chian Wern¹¹,Chuah Soo Lin⁵,Lee Pei Chuen¹¹,Chor Yek Kee¹²,Ngu Louise¹²,Anantasit Nattachai¹³,Liu Chunfeng¹⁴,Xu Wei¹⁴,Wati Dyah Kanya¹⁵¹⁶,Gede Suparyatha Ida Bagus¹⁵¹⁶,Jayashree Muralidharan¹⁷,Liauw Felix¹⁸,Pon Kah Min¹⁹,Huang Li²⁰,Chong Jia Yueh²¹,Zhu Xuemei²²,Hon Kam Lun Ellis²³,Leung Karen Ka Yan²³,Samransamruajkit Rujipat²⁴²⁵,Cheung Yin Bun²²⁶,Lee Jan Hau¹²,

Affiliation:

1. Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore.

2. Duke-NUS Medical School, Singapore.

3. Children’s Hospital of Chongqing Medical University, Chongqing, China.

4. China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.

5. Department of Paediatrics, University Malaya Medical Centre, University Malaya, Kuala Lumpur, Malaysia.

6. Vietnam National Children’s Hospital, Hanoi, Vietnam.

7. Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan.

8. Sultanah Aminah Hospital, Johor, Malaysia.

9. Hospital Tengku Ampuan Rahimah, Selangor, Malaysia.

10. Division of Paediatric Critical Care, National University Hospital, Singapore.

11. Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia.

12. Sarawak General Hospital, Sarawak, Malaysia.

13. Ramathibodi Hospital, Bangkok, Thailand.

14. Shengjing Hospital of China Medical University, Liaoning, China.

15. Pediatric Emergency and Intensive Care Unit, Prof I.G.N.G Ngoerah Hospital, Bali, Indonesia.

16. Medical Faculty, Udayana University, Bali, Indonesia.

17. Postgraduate Institute of Medical Education and Research, Chandigarh, India.

18. Harapan Kita National Women and Children Health Center, Jakarta, Indonesia.

19. Penang General Hospital, Penang, Malaysia.

20. Guangzhou Women and Children’s Medical Center, Guangdong, China.

21. Hospital Tunku Azizah Kuala Lumpur, Kuala Lumpur, Malaysia.

22. Children’s Hospital of Fudan University, Shanghai, China.

23. Paediatric Intensive Care Unit, Hong Kong Children’s Hospital, Hong Kong Special Administrative Region, China.

24. Division of Pediatric Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

25. Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

26. Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland.

Abstract

Objectives: Despite the recommendation for lung-protective mechanical ventilation (LPMV) in pediatric acute respiratory distress syndrome (PARDS), there is a lack of robust supporting data and variable adherence in clinical practice. This study evaluates the impact of an LPMV protocol vs. standard care and adherence to LPMV elements on mortality. We hypothesized that LPMV strategies deployed as a pragmatic protocol reduces mortality in PARDS. Design: Multicenter prospective before-and-after comparison design study. Setting: Twenty-one PICUs. Patients: Patients fulfilled the Pediatric Acute Lung Injury Consensus Conference 2015 definition of PARDS and were on invasive mechanical ventilation. Interventions: The LPMV protocol included a limit on peak inspiratory pressure (PIP), delta/driving pressure (DP), tidal volume, positive end-expiratory pressure (PEEP) to Fio 2 combinations of the low PEEP acute respiratory distress syndrome network table, permissive hypercarbia, and conservative oxygen targets. Measurements and Main Results: There were 285 of 693 (41·1%) and 408 of 693 (58·9%) patients treated with and without the LPMV protocol, respectively. Median age and oxygenation index was 1.5 years (0.4–5.3 yr) and 10.9 years (7.0–18.6 yr), respectively. There was no difference in 60-day mortality between LPMV and non-LPMV protocol groups (65/285 [22.8%] vs. 115/406 [28.3%]; p = 0.104). However, total adherence score did improve in the LPMV compared to non-LPMV group (57.1 [40.0–66.7] vs. 47.6 [31.0–58.3]; p < 0·001). After adjusting for confounders, adherence to LPMV strategies (adjusted hazard ratio, 0.98; 95% CI, 0.97–0.99; p = 0.004) but not the LPMV protocol itself was associated with a reduced risk of 60-day mortality. Adherence to PIP, DP, and PEEP/Fio 2 combinations were associated with reduced mortality. Conclusions: Adherence to LPMV elements over the first week of PARDS was associated with reduced mortality. Future work is needed to improve implementation of LPMV in order to improve adherence.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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