Lung Morphology Assessed by Ultrasound and Positive End-Expiratory Pressure During Mechanical Ventilation for Acute Hypoxemic Respiratory Failure: Secondary Analysis of a Multicenter PICU Cohort From Spain and Portugal, 2020–2021
Ignacio Oulego-Erroz, Mª del Pilar de Castro-Vecino, Rafael González-Cortés, Almudena Alonso-Ojembarrena, Antonio Rodríguez-Núñez, Ainhoa Jiménez-Olmos, Cristina Schüffelmann, Susana Beatriz Reyes-Domínguez, Ana Ortiz-Álvarez, María Slöcker-Barrio, Patricia García-Soler, María García-González, Nerea Ovelar-Zubiaga, Eva Chocano-González, Raúl Borrego-Domínguez, Sonia Brió-Sanagustin, Luis Pérez-Baena, César Villa-Francisco, Javier Rodríguez-Fanjul, Bárbara Fernández-Barrio, Lorena Estepa-Pedregosa, Laia Vega-Puyal, June Udaondo-de Soto, Jorge Rodríguez-Ozcoidi, Orlando Morales-Caballero, Marta Muñoyerro-Sesmero, Laura Díaz-Ruiz, Juan Mayordomo-Colunga, Guillermo Muñiz-AlbaicetaObjectives:
In pediatric patients with acute hypoxemic respiratory failure (AHRF), we aimed to determine whether positive end-expiratory pressure alignment with lung ultrasound (LUS) morphology was associated with shortened duration of mechanical ventilation.
Design:
Exploratory, secondary analysis of a prospective, multicenter cohort study carried out in 2020–2021.
Setting:
Twenty-five PICUs in Spain and Portugal.
Patients:
Children from 1 month to 18 years with AHRF undergoing invasive mechanical ventilation.
Interventions:
None.
Measurements and Main Results:
Data from lung morphology using a 12-zone LUS score between 12 and 48–72 hours after PICU admission were classified as focal or nonfocal. PEEP was considered “aligned with morphology” when greater than or equal to 10 cmH
2
O in cases with nonfocal lung morphology, and less than 10 cmH
2
O in cases with focal morphology. The primary outcome was ventilator-free days (VFDs) at 28 days, analyzed using competing-risk regression and reported as the subdistribution hazard ratio (SHR) with 95% CI. Among 160 children, 101 children (63.1%) had nonfocal morphology. PEEP was aligned with morphology in 84 of 160 children (52.5%). Aligned vs. nonaligned PEEP was associated with lower median (interquartile range [IQR]) driving pressure (13 cmH
2
O [IQR, 12–15 cmH
2
O] vs. 16 cmH
2
O [IQR, 15–18 cmH
2
O];
Conclusions:
In pediatric cases of AHRF, lung ultrasound-defined morphology identifies clinical and physiologic heterogeneity. PEEP aligned with LUS morphology was associated with greater cumulative probability of extubation at 28 days. These multicenter data from Spain and Portugal (2020–2021) suggest that LUS may be a potentially useful bedside tool for personalized mechanical ventilation in children.