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

<h3>Background</h3> 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. <h3>Research Question</h3> What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes? <h3>Study Design and Methods</h3> 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. <h3>Results</h3> 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]; <i>P</i> < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; <i>P</i> = .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 [<i>P</i> < .001]; direct effect, –1.17 [<i>P</i> = .635]; total effect, –5.47 [<i>P</i> = .024]) and IFDs [indirect effect, –3.13 [<i>P</i> < .001]; direct effect, –0.72 [<i>P</i> = .635]; total effect, –3.84 [<i>P</i> = .024]), but not ICU mortality. <h3>Interpretation</h3> 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.

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Journal
CHEST Critical Care
Published
2025-04-22
DOI
https://doi.org/10.1016/j.chstcc.2025.100162
Citations
1
Primary Topic
Respiratory Support and Mechanisms
Type
article
Field-Weighted Citation Impact
1.52
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article

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

Karen Ka Yan Leung, Hiroshi Kurosawa, Kazunori Aoki, Felix Liauw et al.
1 citations
CHEST Critical Care
Respiratory Support and Mechanisms
1.52
article

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

Karen Ka Yan Leung, Hiroshi Kurosawa, Kazunori Aoki, Felix Liauw, Muralidharan Jayashree, Herng Lee Tan, Chian-Wern Tai, Chin Seng Gan, Rehena Sultana, Jan Hau Lee, Jia Yueh Chong, Louise Ngu, Dyah Kanya Wati, Lijia Fan, Hongxing Dang, Nattachai Anantasit, Pei‐Chuen Lee, Kam‐Lun Ellis Hon, Yek Kee Chor, Siew Wah Lee, Phan Hữu Phúc, Soo Lin Chuah, Suparyatha Ida Bagus Gede, Chun‐Feng Liu, Judith Ju‐Ming Wong, Wei Xu, Li Huang, Jacqueline Soo May Ong, Xuemei Zhu, Kah Min Pon, Rujipat Samransamruajkit
article en
1 citations

Abstract

<h3>Background</h3> 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. <h3>Research Question</h3> What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes? <h3>Study Design and Methods</h3> 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. <h3>Results</h3> 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]; <i>P</i> < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; <i>P</i> = .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 [<i>P</i> < .001]; direct effect, –1.17 [<i>P</i> = .635]; total effect, –5.47 [<i>P</i> = .024]) and IFDs [indirect effect, –3.13 [<i>P</i> < .001]; direct effect, –0.72 [<i>P</i> = .635]; total effect, –3.84 [<i>P</i> = .024]), but not ICU mortality. <h3>Interpretation</h3> 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.

CHEST Critical CareVol. 3(3)
Udayana University (ID), University Malaya Medical Centre (MY), Hospital Kuala Lumpur (MY), Sarawak General Hospital (MY), Sultanah Aminah Hospital (MY), King Chulalongkorn Memorial Hospital (TH), Penang Adventist Hospital (MY), China International Science and Technology Cooperation (CN), Duchess of Kent Children's Hospital (CN), Guangzhou Women and Children Medical Center (CN), KK Women's and Children's Hospital (SG), Kobe Children's Hospital (JP), Duke-NUS Medical School (SG), Pembuluh Darah Harapan Kita (ID), Vietnam National Children's Hospital (VN), Ramathibodi Hospital (TH), National University Hospital (SG), Tengku Ampuan Rahimah Hospital (MY), Govind Ballabh Pant Hospital (IN), Children's Hospital of Fudan University (CN), Children's Hospital of Chongqing Medical University (CN), Post Graduate Institute of Medical Education and Research (IN), Chongqing Medical University (CN), National University of Malaysia (MY), China Medical University (CN), Guangzhou Medical University (CN)
Openalex Percentile: Top 20%
Respiratory Support and Mechanisms
1.52
DOIOpen Access PDFOpenAlex
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