Driving Pressure and Normalized Energy Transmission Calculations in Mechanically Ventilated Children Without Lung Disease and Pediatric Acute Respiratory Distress Syndrome
Date
2021
Type:
Article
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Abstract
OBJECTIVES: To compare the new tools to evaluate the energy dissipated to the
lung parenchyma in mechanically ventilated children with and without lung injury.
We compared their discrimination capability between both groups when indexed
by ideal body weight and driving pressure.
DESIGN: Post hoc analysis of individual patient data from two previously published studies describing pulmonary mechanics.
SETTING: Two academic hospitals in Latin-America.
PATIENTS: Mechanically ventilated patients younger than 15 years old were
included. We analyzed two groups, 30 children under general anesthesia
(ANESTH group) and 38 children with pediatric acute respiratory distress
syndrome.
INTERVENTIONS: Respiratory mechanics were measured after intubation in all
patients.
MEASUREMENTS AND MAIN RESULTS: Mechanical power and derived
variables of the equation of motion (dynamic power, driving power, and mechanical energy) were computed and then indexed by ideal body weight. Driving pressure was higher in pediatric acute respiratory distress syndrome group compared
with ANESTH group. Receiver operator curve analysis showed that driving pressure had the best discrimination capability compared with all derived variables
of the equation of motion indexed by ideal body weight. The same results were
observed when the subgroup of patients weighs less than 15kg. There was no
difference in unindexed mechanical power between groups.
CONCLUSIONS: Driving pressure is the variable that better discriminates pediatric acute respiratory distress syndrome from nonpediatric acute respiratory
distress syndrome in children than the calculations derived from the equation of
motion, even when indexed by ideal body weight. Unindexed mechanical power
was useless to differentiate against both groups. Future studies should determine
the threshold for variables of the energy dissipated by the lungs and their association with clinical outcomes.
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Citation
Díaz F, González-Dambrauskas S, Cristiani F, Casanova DR, Cruces P. Driving Pressure and Normalized Energy Transmission Calculations in Mechanically Ventilated Children Without Lung Disease and Pediatric Acute Respiratory Distress Syndrome. Pediatr Crit Care Med. 2021 Oct 1;22(10):870-878. doi: 10.1097/PCC.0000000000002780.
Keywords
Driving power, Driving pressure, Dynamic power, Mechanical energy, Mechanical power, Mechanical ventilation