Shaikh Farhan A R, Ramaswamy Karthik N, Chirla Dinesh K, Venkataraman Shekhar T, Kneyber Martin C J
Department of Pediatric Intensive Care, Rainbow Children's Hospital, Hyderabad, India.
Department of Pediatric Intensive Care, Rainbow Children's Hospital, Chennai, India.
Front Pediatr. 2024 Jan 16;12:1293639. doi: 10.3389/fped.2024.1293639. eCollection 2024.
Mechanical power (MP) refers to the energy transmitted over time to the respiratory system and serves as a unifying determinant of ventilator-induced lung injury. MP normalization is required to account for developmental changes in children. We sought to examine the relationship between mechanical energy (ME), MP normalized to body weight (MP), and MP normalized to respiratory compliance (MP) concerning the severity and outcomes of pediatric acute respiratory distress syndrome (pARDS).
In this retrospective study, children aged 1 month to 18 years diagnosed with pARDS who underwent pressure-control ventilation for at least 24 h between January 2017 and September 2020 were enrolled. We calculated MP using Becher's equation. Multivariable logistic regression analysis adjusted for age, pediatric organ dysfunction score, and oxygenation index (OI) was performed to determine the independent association of MP and its derivatives 24 h after diagnosing pARDS with 28-day mortality. The association was also studied for 28 ventilator-free days (VFD-28) and the severity of pARDS in terms of OI.
Out of 246 admitted with pARDS, 185 were eligible, with an overall mortality of 43.7%. Non-survivors exhibited higher severity of illness, as evidenced by higher values of MP, MP, and ME. Multivariable logistic regression analysis showed that only ME but not MP, MP, or MP at 24 h was independently associated with mortality [adjusted OR: 1.072 (1.002-1.147), = 0.044]. However, after adjusting for the type of pARDS, ME was not independently associated with mortality [adjusted OR: 1.061 (0.992-1.136), = 0.085]. After adjusting for malnutrition, only MP at 24 h was found to be independently associated. Only MP at 1-4 and 24 h but not MP, MP, or ME at 24 h of diagnosing pARDS was significantly correlated with VFD-28.
Normalization of MP is better related to outcomes and severity of pARDS than non-normalized MP. Malnutrition can be a significant confounding factor in resource-limited settings.
机械功率（MP）是指随时间传递至呼吸系统的能量，是呼吸机诱发肺损伤的一个统一决定因素。儿童发育变化需要对MP进行标准化。我们试图研究机械能（ME）、体重标准化机械功率（MP）和呼吸顺应性标准化机械功率（MP）与小儿急性呼吸窘迫综合征（pARDS）的严重程度和预后之间的关系。
在这项回顾性研究中，纳入了2017年1月至2020年9月期间诊断为pARDS且接受压力控制通气至少24小时的1个月至18岁儿童。我们使用贝歇尔方程计算MP。进行多变量逻辑回归分析，对年龄、小儿器官功能障碍评分和氧合指数（OI）进行校正，以确定诊断pARDS后24小时MP及其导数与28天死亡率的独立关联。还研究了该关联与28天无呼吸机天数（VFD-28）以及根据OI评估的pARDS严重程度之间的关系。
在246例因pARDS入院的患者中，185例符合条件，总体死亡率为43.7%。非幸存者的疾病严重程度更高，MP、MP和ME值更高证明了这一点。多变量逻辑回归分析显示，仅24小时的ME而非MP、MP或MP与死亡率独立相关[校正比值比：1.072（1.002-1.147），P = 0.044]。然而，在对pARDS类型进行校正后，ME与死亡率无独立关联[校正比值比：1.061（0.992-1.136），P = 0.085]。在校正营养不良后，发现仅24小时的MP与死亡率独立相关。仅在诊断pARDS后1-4小时和24小时的MP与VFD-28显著相关，而24小时的MP、MP或ME则不然。
与未标准化的MP相比，MP标准化与pARDS的预后和严重程度的相关性更好。在资源有限的环境中，营养不良可能是一个重要的混杂因素。
