Background:There are limited pediatric data evaluating the use PEEP/FIO2 combinations. We aimed to describe PEEP/FIO2 use in pediatric ARDS (PARDS) patients in relation to a PEEP/FIO2 table modified from the ARDSNet protocol in the first 7 days of PARDS. Methods:Data was utilized post-hoc from a before-and-after comparison study of lung protective mechanical ventilation (MV) strategy in children with PARDS. Time-matched PEEP and FIO2 combinations for the first 7 days of ARDS were described in relation to the protocol. We calculated how far the set PEEP for a given FIO2 was from the protocol recommended PEEP. We took the summative score over the 7 days of PARDS diagnosis for analysis. Logistic regression was used for the main outcome of PICU mortality adjusting for low tidal volume ventilation (3–6mL/kg). Results:We identified 138 children with PARDS who required MV from January 2016 to June 2019. Median OI on day 1 was 10.7 (IQR 7.6–16.6). Patients were on conventional MV on 507/808 (62.8%) of PARDS days. PEEP/FIO2 was within protocol limits for 283/507 (55.8%) days, too low on 150/507 (29.6%) days and too high on 74/507 (14.6%) days. 60/133 (45.1%) patients had a summative PEEP/FIO2 score below that recommended by the modified protocol. A summative score below recommendation was associated with increased PICU mortality 15/60 (25.0%) vs. 13/73 (17.8%); P = 0.311, though this was not statistically significant. After adjustment for low tidal volume ventilation, the summative score was not significantly associated with mortality odds ratio 0.97 (95% CI 0.90–1.03). Conclusions:A PEEP/FIO2 combination table adapted from the ARDSNet protocol in patients with PARDS was adhered to on roughly half of ventilation days, but this was not associated with improved survival.
Tan et al. (Fri,) studied this question.