The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort
Background: Lung-protective ventilation strategies, one of which is to limit peak inspiratory pressure (PIP), are recommended in the management of acute respiratory distress syndrome (ARDS). The purpose of this study was to determine whether dynamic pressure gradient, defined as the difference bet...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-07-01
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| Series: | Bali Journal of Anesthesiology |
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| Online Access: | https://journals.lww.com/bjoa/fulltext/2024/08030/the_association_between_dynamic_pressure_gradient.2.aspx |
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| _version_ | 1850195691536646144 |
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| author | Magdalena Rusady Goey I Nyoman Bud Hartawan Dyah Kanya Wati Ida Bagus Gede Suparyatha Siska Sinardja |
| author_facet | Magdalena Rusady Goey I Nyoman Bud Hartawan Dyah Kanya Wati Ida Bagus Gede Suparyatha Siska Sinardja |
| author_sort | Magdalena Rusady Goey |
| collection | DOAJ |
| description | Background:
Lung-protective ventilation strategies, one of which is to limit peak inspiratory pressure (PIP), are recommended in the management of acute respiratory distress syndrome (ARDS). The purpose of this study was to determine whether dynamic pressure gradient, defined as the difference between PIP and positive end-expiratory pressure (PEEP), is associated with pediatric ARDS mortality in the pediatric intensive care unit (PICU).
Materials and Methods:
This was a retrospective, single-center cohort study with consecutive sampling. Children aged 1 month to 18 years with ARDS who were admitted to PICU and used invasive mechanical ventilator between January and December 2023 were included. Patient’s demographic data, pediatric logistic organ dysfunction 2 (PELOD-2) score, oxygenation index (OI), oxygen saturation index (OSI), PEEP, and dynamic pressure gradient were collected from the patient’s medical record. The outcome is mortality, which is measured upon discharge.
Results:
The subjects’ median age was 6 months, predominantly male (64.06%). The etiology of ARDS was pneumonia (90.63%) and sepsis (9.37%). Bivariate analysis showed that dynamic pressure gradient (OR = 4.77, 95% CI=1.47–15.5, P = 0.003), PEEP (OR = 3.21, 95% CI = 1.07–9.52, P = 0.033), and PELOD-2 score at 24–72 h (OR = 3.68, 95% CI = 1.146–11.83, P = 0.024) had a significant association with mortality of ARDS patients at PICU. The results of multivariate analysis showed that dynamic pressure gradient had a significant relationship with the mortality of ARDS patients at PICU (OR = 5.22, 95% CI = 1.47–18.56, P = 0.015).
Conclusion:
Dynamic pressure gradient was associated with mortality in pediatric patients with ARDS who were treated in PICU. |
| format | Article |
| id | doaj-art-cb3a4811daa64d9fa8514a59d620bd8a |
| institution | OA Journals |
| issn | 2549-2276 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Bali Journal of Anesthesiology |
| spelling | doaj-art-cb3a4811daa64d9fa8514a59d620bd8a2025-08-20T02:13:41ZengWolters Kluwer Medknow PublicationsBali Journal of Anesthesiology2549-22762024-07-018313714010.4103/bjoa.bjoa_68_24The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective CohortMagdalena Rusady GoeyI Nyoman Bud HartawanDyah Kanya WatiIda Bagus Gede SuparyathaSiska SinardjaBackground: Lung-protective ventilation strategies, one of which is to limit peak inspiratory pressure (PIP), are recommended in the management of acute respiratory distress syndrome (ARDS). The purpose of this study was to determine whether dynamic pressure gradient, defined as the difference between PIP and positive end-expiratory pressure (PEEP), is associated with pediatric ARDS mortality in the pediatric intensive care unit (PICU). Materials and Methods: This was a retrospective, single-center cohort study with consecutive sampling. Children aged 1 month to 18 years with ARDS who were admitted to PICU and used invasive mechanical ventilator between January and December 2023 were included. Patient’s demographic data, pediatric logistic organ dysfunction 2 (PELOD-2) score, oxygenation index (OI), oxygen saturation index (OSI), PEEP, and dynamic pressure gradient were collected from the patient’s medical record. The outcome is mortality, which is measured upon discharge. Results: The subjects’ median age was 6 months, predominantly male (64.06%). The etiology of ARDS was pneumonia (90.63%) and sepsis (9.37%). Bivariate analysis showed that dynamic pressure gradient (OR = 4.77, 95% CI=1.47–15.5, P = 0.003), PEEP (OR = 3.21, 95% CI = 1.07–9.52, P = 0.033), and PELOD-2 score at 24–72 h (OR = 3.68, 95% CI = 1.146–11.83, P = 0.024) had a significant association with mortality of ARDS patients at PICU. The results of multivariate analysis showed that dynamic pressure gradient had a significant relationship with the mortality of ARDS patients at PICU (OR = 5.22, 95% CI = 1.47–18.56, P = 0.015). Conclusion: Dynamic pressure gradient was associated with mortality in pediatric patients with ARDS who were treated in PICU.https://journals.lww.com/bjoa/fulltext/2024/08030/the_association_between_dynamic_pressure_gradient.2.aspxacute respiratory distress syndrome; dynamic pressure gradient; mortality; pediatric intensive care unit |
| spellingShingle | Magdalena Rusady Goey I Nyoman Bud Hartawan Dyah Kanya Wati Ida Bagus Gede Suparyatha Siska Sinardja The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort Bali Journal of Anesthesiology acute respiratory distress syndrome; dynamic pressure gradient; mortality; pediatric intensive care unit |
| title | The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort |
| title_full | The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort |
| title_fullStr | The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort |
| title_full_unstemmed | The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort |
| title_short | The Association between Dynamic Pressure Gradient and Mortality in Patients with Acute Respiratory Distress Syndrome in a Pediatric Intensive Care Unit: A Single-Center Retrospective Cohort |
| title_sort | association between dynamic pressure gradient and mortality in patients with acute respiratory distress syndrome in a pediatric intensive care unit a single center retrospective cohort |
| topic | acute respiratory distress syndrome; dynamic pressure gradient; mortality; pediatric intensive care unit |
| url | https://journals.lww.com/bjoa/fulltext/2024/08030/the_association_between_dynamic_pressure_gradient.2.aspx |
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