WIP 30 - A comparative analysis of different ventilation strategies on the resolution of severe pediatric acute respiratory distress syndrome

Publication Number: WIP 30.7411

Nikita Tripathi, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Konstantinos Boukas, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Pediatric acute respiratory distress syndrome (pARDS), a heterogeneous lung disease, is a significant cause of respiratory failure in children. Despite advancements in our understanding of pARDS pathophysiology, little has changed in the mortality and long-term outcomes of pediatric patients. No consensus exists on the optimal mode of ventilation for pARDS patients. Low-tidal volume conventional ventilation (LoTV), high frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV) have been utilized, but there is a paucity of pediatric literature demonstrating superiority of one mode of ventilation over another. Understanding how these ventilation strategies compare in terms of outcomes can inform clinical practice changes.

Objective: To evaluate association of APRV, HFOV and LoTV, with time to resolution of severe pARDS defined as oxygenation index (OI) < 16 and ventilator free days (VFD).

Design/Methods: This was a retrospective observational cohort study conducted in a tertiary level pediatric intensive care unit from Jan 2016 to Dec 2023. The study was approved by the Institutional Review Board at UTHealth Houston. Children aged 1 month to 18 years satisfying the severe pARDS criteria according to the Pediatric Acute Lung Injury Consensus Conference Group 2022 guidelines were included. Children with air leak syndrome, increased intracranial pressure and chronic lung disease on home ventilatory support were excluded.
We compared the time to initiation of the three ventilation modalities from day of diagnosis of pARDS to our primary outcome of severe ARDS resolution (based on OI < 16) and VFDs. Secondary morbidity outcomes included PICU and hospital length of stay.
Descriptive statistics will be employed to present data using percent for categorical variables and median and interquartile ranges (IQR) for continuous variables. Outcomes between the three ventilator modality groups will be compared using Kruskal-Wallis analysis. We are currently in the statistical analysis phase, and results are pending.