Wong, Judith Ju Ming and Dang, Hongxing and Gan, Chin Seng and Phan, Phuc Huu and Kurosawa, Hiroshi and Aoki, Kazunori and Lee, Siew Wah and Ong, Jacqueline Soo May and Fan, Li Jia and Tai, Chian Wern and Chuah, Soo Lin and Lee, Pei Chuen and Chor, Yek Kee and Ngu, Louise and Anantasit, Nattachai and Liu, Chunfeng and Xu, Wei and Wati, Dyah Kanya and Gede, Suparyatha Ida Bagus and Jayashree, Muralidharan and Liauw, Felix and Pon, Kah Min and Huang, Li and Chong, Jia Yueh and Zhu, Xuemei and Hon, Kam Lun Ellis and Leung, Karen Ka Yan and Samransamruajkit, Rujipat and Cheung, Yin Bun and Lee, Jan Hau and PACCMAN, Pediatric Acute & Critical Care Med Asian Network (2024) Lung-protective ventilation for pediatric acute respiratory distress syndrome: A nonrandomized controlled trial. Critical Care Medicine, 52 (10). pp. 1602-1611. ISSN 0090-3493, DOI https://doi.org/10.1097/CCM.0000000000006357.
Full text not available from this repository.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 Fio2 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<middle dot>1%) and 408 of 693 (58<middle dot>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<middle dot>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/Fio2 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.
| Item Type: | Article |
|---|---|
| Funders: | Pediatric Academic Clinical Program, Health and Medical Research Fund, Academy of Medicine Malaysia, Thrasher Research Fund, Tan Cheng Lim [Grant no. PAEDSACP-TCL/2020/RES/001], National Medical Research Council [Grant no. FLWP20nov_0002] |
| Uncontrolled Keywords: | Acute lung injury; Artificial ventilation; Children; Mortality; Pediatric intensive care units |
| Subjects: | R Medicine > RJ Pediatrics |
| Divisions: | Faculty of Medicine > Paediatrics Department |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 27 Oct 2025 01:06 |
| Last Modified: | 27 Oct 2025 01:06 |
| URI: | http://eprints.um.edu.my/id/eprint/46430 |
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