The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points

Background: 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. Research Question: What is the association between MP and clinical outcomes, and does impairment in oxygenation m...

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Main Authors:	Herng Lee Tan, MSc, Rehena Sultana, MSc(stat), Phuc Huu Phan, MD, Muralidharan Jayashree, MD, Hongxing Dang, MD, Soo Lin Chuah, MBBS, Chin Seng Gan, MBBS, Siew Wah Lee, MD, Karen Ka Yan Leung, MBBS, MSc, Ellis Kam Lun Hon, MBBS, MD, Xuemei Zhu, MD, Pei Chuen Lee, MMed(Paeds), Chian Wern Tai, MD, Jacqueline Soo May Ong, MB BChir, Lijia Fan, MD, Kah Min Pon, MD, Li Huang, MD, Kazunori Aoki, MD, Hiroshi Kurosawa, MD, PhD, Rujipat Samransamruajkit, MD, Jia Yueh Chong, MD, Felix Liauw, MD, Nattachai Anantasit, MD, Wei Xu, MD, Chunfeng Liu, MD, Jan Hau Lee, MBBS, Louise Ngu, MB BCh BAO, Yek Kee Chor, MD, Suparyatha Ida Bagus Gede, MD, Dyah Kanya Wati, MD, Judith Ju Ming Wong, MB BCh BAO
Format:	Article
Language:	English
Published:	Elsevier 2025-09-01
Series:	CHEST Critical Care
Subjects:	mechanical power mechanical ventilation pediatric ARDS ventilator ventilator-induced lung injury pediatric intensive care unit
Online Access:	http://www.sciencedirect.com/science/article/pii/S2949788425000358
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Summary:	Background: 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. Research Question: What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes? Study Design and Methods: 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. Results: 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]; P < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; P = .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 [P < .001]; direct effect, –1.17 [P = .635]; total effect, –5.47 [P = .024]) and IFDs [indirect effect, –3.13 [P < .001]; direct effect, –0.72 [P = .635]; total effect, –3.84 [P = .024]), but not ICU mortality. Interpretation: 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.
ISSN:	2949-7884

The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points

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