A PEEP/FIO₂ Table in Children With Pediatric ARDS

Abstract

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.