ABSTRACT

Respiratory failure is one of the most common causes of mortality in pediatric intensive care unit (PICU) patients. Adult and a small number of pediatric studies have also associated driving pressure with mortality in ARDS patients, but studies showing the relationship between driving pressure and mortality in patients without ARDS are inconsistent and limited. This study aimed to determine whether driving pressure was associated with mortality in pediatric patients diagnosed as pediatric ARDS (pARDS) and non-pARDS who received mechanical ventilation support due to respiratory failure.

Mechanically ventilated patients were recorded if the foreseen ventilation duration was more than 24 hours. Driving pressure and other ventilator parameters of patients in the pARDS and non-pARDS groups were compared with their 30-day mortality.

A total of 116 children were included in our study. 34 patients were classified in pARDS group, whereas 82 patients werein non-PARDS group. All patients’first day of mechanical ventilation parameters [ΔP (p<0,001), PIP (p<0,001), Pplat (p<0,001), Pmean (p=0,008), Cstat (p<0,001), Cstat/IBW (p<0,001), FiO2 (p=0,001)] werefound to be associated with hospital mortality. Driving pressure and other ventilator parameters associated with mortality in the univariate analysis were further evaluated by logistic regression analysis and driving pressure was determined as the most associated ventilator parameter with mortality (OR=1,51, 95% CI 1.24 to 1.82, p = <0.001). We assessed independently the relationship between ΔP and mortality in patients non-pARDS and pARDS and we found ΔP was related to mortality in both patients (OR=1,59, 95% CI 1.06 to 2.36, p <0.022) and non-ARDS patients (OR=1,47, 95% CI 1.09 to 1.98, p <0.010). We identified a driving pressure cut-off value of 14,5 cmH2O for all patient groups.

Driving pressure was significantly associated with an increased risk of mortality among mechanically ventilated both pARDS and non-pARDS patients.