Lung Morphology Assessed by Ultrasound and Positive End-Expiratory Pressure During Mechanical Ventilation for Acute Hypoxemic Respiratory Failure: Secondary Analysis of a Multicenter PICU Cohort From Spain and Portugal, 2020–2021

OBJECTIVES: In pediatric patients with acute hypoxemic respiratory failure (AHRF), we aimed to determine whether positive end-expiratory pressure alignment with lung ultrasound (LUS) morphology was associated with shortened duration of mechanical ventilation. DESIGN: Exploratory, secondary analysis of a prospective, multicenter cohort study carried out in 2020-2021. SETTING: Twenty-five PICUs in Spain and Portugal. PATIENTS: Children from 1 month to 18 years with AHRF undergoing invasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data from lung morphology using a 12-zone LUS score between 12 and 48-72 hours after PICU admission were classified as focal or nonfocal. PEEP was considered "aligned with morphology" when greater than or equal to 10 cmH2O in cases with nonfocal lung morphology, and less than 10 cmH2O in cases with focal morphology. The primary outcome was ventilator-free days (VFDs) at 28 days, analyzed using competing-risk regression and reported as the subdistribution hazard ratio (SHR) with 95% CI. Among 160 children, 101 children (63.1%) had nonfocal morphology. PEEP was aligned with morphology in 84 of 160 children (52.5%). Aligned vs. nonaligned PEEP was associated with lower median (interquartile range [IQR]) driving pressure (13 cmH2O [IQR, 12-15 cmH2O] vs. 16 cmH2O [IQR, 15-18 cmH2O]; p < 0.001) and higher median VFDs (22 [IQR, 19-24] vs. 17 [IQR, 12-19]; p < 0.001). In adjusted competing-risk models, PEEP alignment with lung morphology was associated with greater cumulative probability of extubation at 28 days (SHR, 1.87 [95% CI, 1.30-2.69]). Stratified analyses confirmed the associated greater probability for both focal (SHR, 1.96 [95% CI, 1.20-3.21]) and nonfocal morphology cases (SHR, 2.23 [95% CI, 1.30-3.82]). CONCLUSIONS: In pediatric cases of AHRF, lung ultrasound-defined morphology identifies clinical and physiologic heterogeneity. PEEP aligned with LUS morphology was associated with greater cumulative probability of extubation at 28 days. These multicenter data from Spain and Portugal (2020-2021) suggest that LUS may be a potentially useful bedside tool for personalized mechanical ventilation in children.

Authors

Institutions

Publication Details

Journal
Pediatric Critical Care Medicine
Published
2026-11-04
DOI
https://doi.org/10.1097/pcc.0000000000004073
Primary Topic
Respiratory Support and Mechanisms
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Lung Morphology Assessed by Ultrasound and Positive End-Expiratory Pressure During Mechanical Ventilation for Acute Hypoxemic Respiratory Failure: Secondary Analysis of a Multicenter PICU Cohort From Spain and Portugal, 2020–2021

Luis Perez‐Baena, Jorge Rodríguez-Ozcoidi, Almudena Alonso‐Ojembarrena, María García-González et al.
Pediatric Critical Care Medicine
Respiratory Support and Mechanisms
article

Lung Morphology Assessed by Ultrasound and Positive End-Expiratory Pressure During Mechanical Ventilation for Acute Hypoxemic Respiratory Failure: Secondary Analysis of a Multicenter PICU Cohort From Spain and Portugal, 2020–2021

Luis Perez‐Baena, Jorge Rodríguez-Ozcoidi, Almudena Alonso‐Ojembarrena, María García-González, Javier Rodríguez‐Fanjul, Juan Mayordomo‐Colunga, María Slöcker-Barrio, Susana Beatriz Reyes, Bárbara Fernández Barrio, Guillermo Muñiz, Patricia García-Soler, Ignacio Oulego‐Erroz, Ainhoa Jiménez Olmos, June Udaondo, Ana Ortiz-Álvarez, Laia Vega, Antonio Rodrı́guez-Núñez, Lorena Estepa‐Pedregosa, M. Muñoyerro, Raúl Borrego-Domínguez, Cristina Schüffelmann, Orlando Morales-Caballero, Sonia Brió-Sanagustin, Laura Díaz-Ruiz, Rafael González-Cortés, Mª del Pilar de Castro-Vecino, Eva Chocano-González, César Villa-Francisco, Nerea Ovelar-Zubiaga
article en

Abstract

OBJECTIVES: In pediatric patients with acute hypoxemic respiratory failure (AHRF), we aimed to determine whether positive end-expiratory pressure alignment with lung ultrasound (LUS) morphology was associated with shortened duration of mechanical ventilation. DESIGN: Exploratory, secondary analysis of a prospective, multicenter cohort study carried out in 2020-2021. SETTING: Twenty-five PICUs in Spain and Portugal. PATIENTS: Children from 1 month to 18 years with AHRF undergoing invasive mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data from lung morphology using a 12-zone LUS score between 12 and 48-72 hours after PICU admission were classified as focal or nonfocal. PEEP was considered "aligned with morphology" when greater than or equal to 10 cmH2O in cases with nonfocal lung morphology, and less than 10 cmH2O in cases with focal morphology. The primary outcome was ventilator-free days (VFDs) at 28 days, analyzed using competing-risk regression and reported as the subdistribution hazard ratio (SHR) with 95% CI. Among 160 children, 101 children (63.1%) had nonfocal morphology. PEEP was aligned with morphology in 84 of 160 children (52.5%). Aligned vs. nonaligned PEEP was associated with lower median (interquartile range [IQR]) driving pressure (13 cmH2O [IQR, 12-15 cmH2O] vs. 16 cmH2O [IQR, 15-18 cmH2O]; p < 0.001) and higher median VFDs (22 [IQR, 19-24] vs. 17 [IQR, 12-19]; p < 0.001). In adjusted competing-risk models, PEEP alignment with lung morphology was associated with greater cumulative probability of extubation at 28 days (SHR, 1.87 [95% CI, 1.30-2.69]). Stratified analyses confirmed the associated greater probability for both focal (SHR, 1.96 [95% CI, 1.20-3.21]) and nonfocal morphology cases (SHR, 2.23 [95% CI, 1.30-3.82]). CONCLUSIONS: In pediatric cases of AHRF, lung ultrasound-defined morphology identifies clinical and physiologic heterogeneity. PEEP aligned with LUS morphology was associated with greater cumulative probability of extubation at 28 days. These multicenter data from Spain and Portugal (2020-2021) suggest that LUS may be a potentially useful bedside tool for personalized mechanical ventilation in children.

Pediatric Critical Care Medicine
Universidad Complutense de Madrid (ES), Universitat Autònoma de Barcelona (ES), Universidad de Oviedo (ES), Hospital Universitario La Paz (ES), Instituto de Salud Carlos III (ES), Hospital de Sant Pau (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitario Nuestra Señora de Candelaria (ES), Hospital Universitario Dexeus (ES), Complejo Hospitalario Universitario de Santiago (ES), Complejo Hospitalario de Salamanca (ES), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES), Hospital Universitario 12 De Octubre (ES), Hospital Regional Universitario de Málaga (ES), Hospital Virgen de la Salud (ES), Hospital Universitario Miguel Servet (ES), Centro de Investigación Biomédica en Red (ES), Hospital Universitario de Burgos (ES), Biomedical Research and Innovation Institute of Cadiz (ES), Hospital Universitario Central de Asturias (ES), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES), Hospital de Cruces (ES), Donostiako Unibertsitate Ospitalea (ES), Hospital Universitario Puerta del Mar (ES), Hospital Universitario Virgen de la Arrixaca (ES), Hospital Universitario Son Espases (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Universitari Germans Trias i Pujol (ES), Instituto de Investigación Sanitaria del Principado de Asturias (ES), Instituto de Investigación Sanitaria Gregorio Marañón (ES), Complejo Asistencial Universitario de León (ES), Red de Salud Materno Infantil y del Desarrollo (ES), Universidad de León (ES)
Openalex Percentile: Top 13%
Respiratory Support and Mechanisms
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.

Laika access coming soon