Show simple item record

dc.contributor.authorWard, Shan L.
dc.contributor.authorQuinn, Carson M.
dc.contributor.authorValentine, Stacey L.
dc.contributor.authorSapru, Anil
dc.contributor.authorCurley, Martha A. Q
dc.contributor.authorWillson, Douglas F.
dc.contributor.authorLiu, Kathleen D.
dc.contributor.authorMatthay, Michael A.
dc.contributor.authorFlori, Heidi R.
dc.date2022-08-11T08:10:14.000
dc.date.accessioned2022-08-23T17:00:23Z
dc.date.available2022-08-23T17:00:23Z
dc.date.issued2016-10-01
dc.date.submitted2016-11-16
dc.identifier.citationPediatr Crit Care Med. 2016 Oct;17(10):917-923. <a href="http://dx.doi.org/10.1097/PCC.0000000000000903">Link to article on publisher's site</a>
dc.identifier.issn1529-7535 (Linking)
dc.identifier.doi10.1097/PCC.0000000000000903
dc.identifier.pmid27513687
dc.identifier.urihttp://hdl.handle.net/20.500.14038/43785
dc.description.abstractOBJECTIVES: To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence. DESIGN: Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies. SETTING: Twenty-six academic PICU. PATIENTS: Three hundred fifteen pediatric acute respiratory distress syndrome patients. MEASUREMENTS AND MAIN RESULTS: All patients who received conventional mechanical ventilation at hours 0 and 24 of pediatric acute respiratory distress syndrome who had data to calculate ideal body weight were included. Two cutoff points for low-tidal volume ventilation were assessed: less than or equal to 6.5 mL/kg of ideal body weight and less than or equal to 8 mL/kg of ideal body weight. Of 555 patients, we excluded 240 for other respiratory support modes or missing data. The remaining 315 patients had a median PaO2-to-FIO2 ratio of 140 (interquartile range, 90-201), and there were no differences in demographics between those who did and did not receive low-tidal volume ventilation. With tidal volume cutoff of less than or equal to 6.5 mL/kg of ideal body weight, the adherence rate was 32% at hour 0 and 33% at hour 24. A low-tidal volume ventilation cutoff of tidal volume less than or equal to 8 mL/kg of ideal body weight resulted in an adherence rate of 58% at hour 0 and 60% at hour 24. Low-tidal volume ventilation use was no different by severity of pediatric acute respiratory distress syndrome nor did adherence improve over time. At hour 0, overweight children were less likely to receive low-tidal volume ventilation less than or equal to 6.5 mL/kg ideal body weight (11% overweight vs 38% nonoverweight; p = 0.02); no difference was noted by hour 24. Furthermore, in the overweight group, using admission weight instead of ideal body weight resulted in misclassification of up to 14% of patients as receiving low-tidal volume ventilation when they actually were not. CONCLUSIONS: Low-tidal volume ventilation is underused in the first 24 hours of pediatric acute respiratory distress syndrome. Age, Pediatric Risk of Mortality-III, and pediatric acute respiratory distress syndrome severity were not associated with improved low-tidal volume ventilation adherence nor did adherence improve over time. Overweight children were less likely to receive low-tidal volume ventilation strategies in the first day of illness.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=27513687&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1097/PCC.0000000000000903
dc.subjectCritical Care
dc.subjectPediatrics
dc.subjectPulmonology
dc.subjectRespiratory Tract Diseases
dc.titlePoor Adherence to Lung-Protective Mechanical Ventilation in Pediatric Acute Respiratory Distress Syndrome
dc.typeJournal Article
dc.source.journaltitlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
dc.source.volume17
dc.source.issue10
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/peds_pp/95
dc.identifier.contextkey9383597
html.description.abstract<p>OBJECTIVES: To determine the frequency of low-tidal volume ventilation in pediatric acute respiratory distress syndrome and assess if any demographic or clinical factors improve low-tidal volume ventilation adherence.</p> <p>DESIGN: Descriptive post hoc analysis of four multicenter pediatric acute respiratory distress syndrome studies.</p> <p>SETTING: Twenty-six academic PICU.</p> <p>PATIENTS: Three hundred fifteen pediatric acute respiratory distress syndrome patients.</p> <p>MEASUREMENTS AND MAIN RESULTS: All patients who received conventional mechanical ventilation at hours 0 and 24 of pediatric acute respiratory distress syndrome who had data to calculate ideal body weight were included. Two cutoff points for low-tidal volume ventilation were assessed: less than or equal to 6.5 mL/kg of ideal body weight and less than or equal to 8 mL/kg of ideal body weight. Of 555 patients, we excluded 240 for other respiratory support modes or missing data. The remaining 315 patients had a median PaO2-to-FIO2 ratio of 140 (interquartile range, 90-201), and there were no differences in demographics between those who did and did not receive low-tidal volume ventilation. With tidal volume cutoff of less than or equal to 6.5 mL/kg of ideal body weight, the adherence rate was 32% at hour 0 and 33% at hour 24. A low-tidal volume ventilation cutoff of tidal volume less than or equal to 8 mL/kg of ideal body weight resulted in an adherence rate of 58% at hour 0 and 60% at hour 24. Low-tidal volume ventilation use was no different by severity of pediatric acute respiratory distress syndrome nor did adherence improve over time. At hour 0, overweight children were less likely to receive low-tidal volume ventilation less than or equal to 6.5 mL/kg ideal body weight (11% overweight vs 38% nonoverweight; p = 0.02); no difference was noted by hour 24. Furthermore, in the overweight group, using admission weight instead of ideal body weight resulted in misclassification of up to 14% of patients as receiving low-tidal volume ventilation when they actually were not.</p> <p>CONCLUSIONS: Low-tidal volume ventilation is underused in the first 24 hours of pediatric acute respiratory distress syndrome. Age, Pediatric Risk of Mortality-III, and pediatric acute respiratory distress syndrome severity were not associated with improved low-tidal volume ventilation adherence nor did adherence improve over time. Overweight children were less likely to receive low-tidal volume ventilation strategies in the first day of illness.</p>
dc.identifier.submissionpathpeds_pp/95
dc.contributor.departmentDepartment of Pediatrics, Division of Critical Care
dc.source.pages917-923


This item appears in the following Collection(s)

Show simple item record