Mechanical Power Is Associated With Mortality in Pediatric Acute Respiratory Distress Syndrome
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Pulmonary, Pediatrics, Procedures, 2022
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INTRODUCTION: Mechanical power (MP) transferred from the ventilator to the lungs has been proposed as a summary variable that may impact mortality in patients with acute respiratory distress syndrome (ARDS). We investigated the association between high MP and 28-day mortality, as well as the individual components that may drive this association. METHODS: We performed a secondary analysis of a prospectively enrolled cohort of pediatric ARDS (Berlin and PALICC criteria) admitted between January 2013 and December 2019, excluding subjects on non-conventional ventilation. All patients received conventional ventilation with decelerating flow. MP was calculated from variables at ARDS onset, and multivariable Cox regression was used to test for association between individual variables comprising MP, as well as MP itself, with 28-day mortality. We adjusted for age, PaCO2, initial PaO2/FIO2, vasopressor score, organ failures, and immunocompromised status. Finally, we tested whether there remained an association when specific terms were removed from the MP equation by calculating static strain (remove delta P [PIP minus PEEP]), dynamic strain (remove PEEP), and mechanical energy (remove respiratory rate).  RESULTS: Five hundred forty-six children were eligible, with a median PaO2/FIO2 of 162 (IQR 110, 225) and age 5.7 years (IQR 1.8, 12.9). Higher MP was associated with increased mortality (HR 1.34 per 1 SD increase, 95% CI 1.08 to 1.65, p=0.007). When assessing the contribution of individual components, only PEEP was associated with mortality (HR 1.32, p=0.007), while tidal volume, respiratory rate, and delta P were not. Static strain (HR 1.44, p < 0.001), dynamic strain (HR 1.25, p=0.042), and mechanical energy (HR 1.29, p=0.009) were all associated with mortality. CONCLUSIONS: This is the largest reported cohort in which MP has been evaluated in pediatric ARDS. We found that higher MP is associated with mortality, and that PEEP appears to be the component most consistently driving this association. As higher PEEP is used in sicker patients, the association between MP and mortality may simply reflect a marker of illness severity rather than MP itself being causal for mortality. However, our results also support future trials conducting different levels of PEEP in children with ARDS.
Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Pediatrics
Knowledge Area Procedures
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Acute Respiratory Distress Syndrome ARDS
Tag Pediatrics
Tag Mechanical Ventilation
Tag Respiratory Failure
Year 2022
mechanical power
pediatric acute respiratory distress syndrome
lung injury
ventilator settings
pediatric ARDS patients


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