The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDS

CHEST critical care Pub Date : 2025-04-22 DOI:10.1016/j.chstcc.2025.100162

Herng Lee Tan MSc , Rehena Sultana MSc(stat) , Phuc Huu Phan MD , Muralidharan Jayashree MD , Hongxing Dang MD , Soo Lin Chuah MBBS , Chin Seng Gan MBBS , Siew Wah Lee MD , Karen Ka Yan Leung MBBS, MSc , Ellis Kam Lun Hon MBBS, MD , Xuemei Zhu MD , Pei Chuen Lee MMed(Paeds) , Chian Wern Tai MD , Jacqueline Soo May Ong MB BChir , Lijia Fan MD , Kah Min Pon MD , Li Huang MD , Kazunori Aoki MD , Hiroshi Kurosawa MD, PhD , Rujipat Samransamruajkit MD , Judith Ju Ming Wong MB BCh BAO

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Abstract

Background

The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect.

Research Question

What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes?

Study Design and Methods

This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder.

Results

A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were < 0.2262 J/min/kg, 0.2262 to 0.4487 J/min/kg, and > 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; P < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; P = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [P < .001]; direct effect, –1.17 [P = .635]; total effect, –5.47 [P = .024]) and IFDs [indirect effect, –3.13 [P < .001]; direct effect, –0.72 [P = .635]; total effect, –3.84 [P = .024]), but not ICU mortality.

Interpretation

In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation.

查看原文本刊更多论文

机械功率归一化预测体重对儿童ARDS预后的影响

背景：目前文献对儿童ARDS （PARDS）中机械动力（MP）的研究还不够深入，限制了我们对其潜在有害影响的理解。研究问题：MP与临床结果之间的关系是什么？氧合损伤是否介导MP与临床结果之间的关系？研究设计和方法本研究对来自21个picu的PARDS患儿的前后研究数据进行了事后因果中介分析。我们使用简化的MP计算压力控制和容量控制通气归一化到预测体重。我们确定了低、中等和高的MP截止值，并使用多变量回归来确定MP类别与ICU死亡率、28天无呼吸机天数（vfd）和无ICU天数（IFDs）之间的关系，调整了儿科死亡率指数3评分、儿科Logistic器官功能障碍2评分、氧合指数（OI）和年龄。进行了因果中介分析，以估计MP对治疗氧合损伤（以OI为代表）的结果的因果效应为中介，年龄为混杂因素。结果共纳入466例患者。低、中、高MP的截止值为<；0.2262 J/min/kg, 0.2262 ~ 0.4487 J/min/kg, >；0.4487 J/min/kg。MP高低与vfd降低相关(调整后的发病率比，-0.22 [95% CI, -0.35至-0.10]；P & lt;.001)和ifd(校正发病率比，-0.14 [95% CI, -0.27至-0.01]；P = 0.034)，但与ICU死亡率无关。在因果分析中，OI对MP对vfd的因果通路有显著的间接影响（间接影响，-4.30）[P <；措施);直接效应，-1.17 [P = .635]；总效应，-5.47 [P = 0.024])和ifd[间接效应，-3.13 [P <；措施);直接效应，-0.72 [P = .635]；总有效率为-3.84 [P = 0.024])，但与ICU死亡率无关。在本研究中，较高的MP与较少的vfd和ifd相关。MP对vfd和IFDs的因果作用完全由氧合损伤介导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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