Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Pediatr Pulmonol. 2022 Oct;57(10):2464-2473. doi: 10.1002/ppul.26060. Epub 2022 Jul 14.
Low tidal volume and adequate positive end-expiratory pressure (PEEP) are evidence-based approaches for pediatric acute respiratory distress syndrome (pARDS), however, data are limited regarding their use since pARDS guidelines were revised in 2015.
To identify prevalence of, and factors associated with, nonadherence to appropriate tidal volume and PEEP in children with pARDS.
Retrospective cohort study of children 1 month to <18 years with pARDS who received invasive mechanical ventilation from 2016 to 2018 in a single pediatric intensive care unit (PICU).
At 24 h after meeting pARDS criteria, 48/86 (56%) patients received tidal volume ≤8 ml/kg of ideal body weight and 45/86 (52%) received appropriate PEEP, with 22/86 (26%) receiving both. Among patients ≥2 years of age, a lower proportion of patients with overweight/obesity (9/25, 36%) had appropriate tidal volume versus those in the normal or underweight category (16/22, 73%, p = 0.02). When FIO was ≥50%, PEEP was appropriate in 19/60 (32%) cases versus 26/26 (100%) with FIO < 50% (p < 0.0001). pARDS was documented in the progress note in 7/86 (8%) patients at 24 h. Severity of pARDS, documentation in the progress note, and other clinical factors were not significantly associated with use of appropriate tidal volume and PEEP, however pARDS was documented more commonly in patients with severe pARDS.
In a single PICU in the United States, children with pARDS did not receive appropriate tidal volume for ideal body weight nor PEEP. Targets for improving tidal volume and PEEP adherence may include overweight patients and those receiving FIO ≥ 50%, respectively.
低潮气量和适当的呼气末正压（PEEP）是小儿急性呼吸窘迫综合征（pARDS）的循证治疗方法，但自 2015 年 pARDS 指南修订以来，关于其使用的数据有限。
确定患有 pARDS 的儿童中不符合适当潮气量和 PEEP 的流行率和相关因素。
这是一项回顾性队列研究，纳入了 2016 年至 2018 年期间在单一儿科重症监护病房（PICU）接受有创机械通气的 1 个月至<18 岁的 pARDS 患儿。
在符合 pARDS 标准后 24 小时，48/86（56%）名患者接受了≤8ml/kg 理想体重的潮气量，45/86（52%）名患者接受了适当的 PEEP，其中 22/86（26%）名患者同时接受了这两种治疗。在≥2 岁的患者中，超重/肥胖患者（9/25，36%）中接受适当潮气量的比例低于正常或体重不足患者（16/22，73%，p=0.02）。当 FIO₂≥50%时，60 例患者中有 19 例（32%）的 PEEP 适当，而 FIO₂<50%的 26 例患者（100%）中 PEEP 适当（p<0.0001）。在 86 例患者中，有 7 例（8%）在 24 小时时记录了 pARDS 的病程记录。pARDS 的严重程度、病程记录中的记录以及其他临床因素与使用适当的潮气量和 PEEP 无显著相关性，但在严重 pARDS 患者中更常记录 pARDS。
在美国的一家 PICU 中，患有 pARDS 的儿童未接受理想体重的适当潮气量或 PEEP。可能需要针对超重患者和接受 FIO₂≥50%的患者来提高潮气量和 PEEP 治疗的依从性。
