Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS). Retrospective analysis of a prospective observational international cohort study. There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure—positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min−1·Kg−1 Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), p = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min−1·Kg−1 OR 1.12 [0.94, 1.32], p = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min−1·Kg−1 OR 1.22 [1.01, 1.46], p = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min−1·Kg−1 SHR 0.89 (0.82, 0.96), p = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO2 than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD. Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation. Take Home Message: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.

中文翻译：

---

小儿急性呼吸窘迫综合征的机械功率：PARDIE 研究

机械功率是随着时间的推移传输到呼吸系统的能量的复合变量，与单独的呼吸机管理组件相比，机械功率可以更好地捕获呼吸机引起的肺损伤的风险。我们试图评估高机械功率的机械通气管理是否与小儿急性呼吸窘迫综合征 (PARDS) 儿童的无呼吸机天数 (VFD) 减少相关。一项前瞻性观察性国际队列研究的回顾性分析。其中包括来自 55 个儿科重症监护病房的 306 名儿童。高机械功率与年轻年龄、较高氧合指数、支气管肺发育不良合并症、较高潮气量、较高德尔塔压力（吸气峰值压力-呼气末正压）和较高呼吸频率相关。在控制混杂变量后，较高的机械功率与较少的 28 天 VFD 相关（每 0.1 J·min−1·Kg−1 子分布风险比 (SHR) 0.93 (0.87, 0.98)，p = 0.013）。在整个队列的多变量分析中，较高的机械功率与较高的重症监护病房死亡率无关（每 0.1 J·min−1·Kg−1 或 1.12 [0.94, 1.32]，p = 0.20）。但当排除因神经系统原因死亡的儿童时，与较高的死亡率相关（每 0.1 J·min−1·Kg−1 OR 1.22 [1.01, 1.46]，p = 0.036）。在按年龄进行的亚组分析中，较高的机械功率与较少的 28 天 VFD 之间的关联仅在 < 2 岁的儿童中存在（每 0.1 J·min−1·Kg−1 SHR 0.89 (0.82, 0.96)，p = 0.005）。与年龄较大的儿童相比，年龄较小的儿童的潮气量较低，压差较高，呼吸频率较高，呼气末正压较低，PCO2 较高。没有单独的呼吸机管理组件调节机械功率对 28 天 VFD 的影响。PARDS 儿童的机械功率越高，28 天的 VFD 次数越少。这种关联在 2 岁以下的儿童中最为明显，他们的机械通气管理存在显着差异。虽然需要进一步验证，但这些数据强调，呼吸机管理与 PARDS 儿童的预后相关，并且可能有一些儿童亚组从改善肺保护性通气的策略中获得更高的潜在益处。小知识：对于患有小儿急性呼吸窘迫综合征的儿童，较高的机械功率与较少的 28 天不使用呼吸机的天数相关。这种关联在 2 岁以下的儿童中最为明显，他们的机械通气管理存在显着差异。