• Jaime Fernández-Sarmiento, Ana María Bejarano-Quintero, Jose Daniel Tibaduiza, Karen Moreno-Medina, Rosalba Pardo, Luz Marina Mejía, Jose Luis Junco, Jorge Rojas, Oscar Peña, Yomara Martínez, Ledys Izquierdo, Maria Claudia Guzmán, Pablo Vásquez-Hoyos, Milton Molano, Carlos Gallon, Carolina Bonilla, Maria Carolina Fernández-Palacio, Valentina Merino, Christian Bernal, Juan Pablo Fernández-Sarta, Estefanía Hernandez, Isabela Alvarez, Juan Camilo Tobo, Maria Camila Beltrán, Juanita Ortiz, Laura Botia, Jose Manuel Fernández-Rengifo, Rocio Del Pilar Pereira-Ospina, Alexandra Blundell, Andres Nieto, and Catalina Duque-Arango.
• Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia.
• Pediatr Crit Care Me. 2024 Sep 1; 25 (9): 848857848-857.

ObjectivesHigh driving pressure (DP, ratio of tidal volume (V t ) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality.DesignMulticenter, prospective study conducted between February 2018 and December 2022.SettingTwelve tertiary care PICUs in Colombia.PatientsOne hundred eighty-four intubated children with moderate to severe PARDS.InterventionsNone.Measurements And Main ResultsThe median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H 2 O, p < 0.01). Of note, children with a V t less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H 2 O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H 2 O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02).ConclusionsIn children with moderate to severe PARDS, a DP greater than 15 cm H 2 O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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