Transpulmonary Pressure-Guided Mechanical Ventilation in Severe Acute Respiratory Distress Syndrome in the PICU: Single-Center Retrospective Study in North India, 2018-2021.

OBJECTIVES

In this study, we have reviewed the association between esophageal pressure-guided positive end-expiratory pressure (PEEP) setting and oxygenation and lung mechanics with a conventional mechanical ventilation (MV) strategy in patient with moderate to severe pediatric acute respiratory distress syndrome (PARDS).

DESIGN

Retrospective cohort, 2018-2021.

SETTING

Tertiary PICU.

PATIENTS

Moderate to severe PARDS patients who required MV with PEEP of greater than or equal to 8 cm H 2 O.

INTERVENTIONS

Esophageal pressure (i.e., transpulmonary pressure [P TP ]) guided MV vs. not.

MEASUREMENTS AND MAIN RESULTS

We identified 26 PARDS cases who were divided into those who had been managed with P TP -guided MV (P TP group) and those managed with conventional ventilation strategy (non-P TP ). Oxygenation and lung mechanics were compared between groups at baseline (0 hr) and 24, 48, and 72 hours of MV. There were 13 patients in each group in the first 24 hours. At 48 and 72 hours, there were 11 in P TP group and 12 in non-P TP group. On comparing these groups, first, use of P TP monitoring was associated with higher median (interquartile range) mean airway pressure at 24 hours (18 hr [18-20 hr] vs. 15 hr [13-18 hr]; p = 0.01) and 48 hours (19 hr [17-19 hr] vs. 15 hr [13-17 hr]; p = 0.01). Second, use of P TP was associated with higher PEEP at 24, 48, and 72 hours (all p < 0.05). Third, use of P TP was associated with lower F io2 and greater Pa o2 to F io2 ratio at 72 hours. Last, there were 18 of 26 survivors, and we failed to identify an association between use of P TP monitoring and survival.

CONCLUSIONS

In this cohort of moderate to severe PARDS cases undergoing MV with PEEP greater than or equal to 8 cm H 2 O, we have identified some favorable associations of oxygenation status when P TP -guided MV was used vs. not. Larger studies are required.