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Controlled Clinical Trial
. 2024 Oct 1;52(10):1602-1611.
doi: 10.1097/CCM.0000000000006357. Epub 2024 Jun 26.

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

Judith Ju Ming Wong  1   2 , Hongxing Dang  3   4 , Chin Seng Gan  5 , Phuc Huu Phan  6 , Hiroshi Kurosawa  7 , Kazunori Aoki  7 , Siew Wah Lee  8   9 , Jacqueline Soo May Ong  10 , Li Jia Fan  10 , Chian Wern Tai  11 , Soo Lin Chuah  5 , Pei Chuen Lee  11 , Yek Kee Chor  12 , Louise Ngu  12 , Nattachai Anantasit  13 , Chunfeng Liu  14 , Wei Xu  14 , Dyah Kanya Wati  15   16 , Suparyatha Ida Bagus Gede  15   16 , Muralidharan Jayashree  17 , Felix Liauw  18 , Kah Min Pon  19 , Li Huang  20 , Jia Yueh Chong  21 , Xuemei Zhu  22 , Kam Lun Ellis Hon  23 , Karen Ka Yan Leung  23 , Rujipat Samransamruajkit  24   25 , Yin Bun Cheung  2   26 , Jan Hau Lee  1   2 ; Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN)
Collaborators, Affiliations
Controlled Clinical Trial

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

Judith Ju Ming Wong et al. Crit Care Med. .

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 F io2 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/F io2 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.

Trial registration: ClinicalTrials.gov NCT04068038.

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Conflict of interest statement

Dr. Wong’s institution received funding from the Pediatric Academic Clinical Program/Nurturing Clinician Scientist Scheme (2020), the National Medical Research Council (NMRC) Research Training Fellowship (FLWP20nov_0002), and the Academy of Medicine Malaysia. Drs. Wong’s and Lee’s institutions received funding from the NMRC Singapore. Dr. Pon disclosed government work. Dr. Hon’s institution received funding from the Health and Medical Research Fund. Dr. Jan Hau Lee’s institution received funding from the Thrasher foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Brower RG, Matthay MA, Morris A, et al.; Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342:1301–1308
    1. Dreyfuss D, Soler P, Basset G, et al.: High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis. 1988; 137:1159–1164
    1. Amato MB, Barbas CS, Medeiros DM, et al.: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998; 338:347–354
    1. Petrucci N, Iacovelli W: Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev. 2004; (2):CD003844
    1. Amato MBP, Meade MO, Slutsky AS, et al.: Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015; 372:747–755

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