1
|
Modesto-Alapont V, Medina A, Mayordomo-Colunga J. Breaking Circular Thinking about the Value of Oxygenation. Am J Respir Crit Care Med 2020; 202:299-300. [PMID: 32459509 PMCID: PMC7365371 DOI: 10.1164/rccm.202004-1114le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Alberto Medina
- Hospital Universitario Central de AsturiasOviedo, Spain
- Instituto de Investigación Sanitaria del Principado de AsturiasOviedo, Spainand
| | - Juan Mayordomo-Colunga
- Hospital Universitario Central de AsturiasOviedo, Spain
- Instituto de Investigación Sanitaria del Principado de AsturiasOviedo, Spainand
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES) Madrid, Spain
| |
Collapse
|
2
|
López-Fernández YM, Smith LS, Kohne JG, Weinman JP, Modesto-Alapont V, Reyes-Dominguez SB, Medina A, Piñeres-Olave BE, Mahieu N, Klein MJ, Flori HR, Jouvet P, Khemani RG. Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study. Intensive Care Med 2020; 46:1382-1393. [PMID: 32451578 PMCID: PMC7246298 DOI: 10.1007/s00134-020-06074-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
Purpose Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Electronic supplementary material The online version of this article (10.1007/s00134-020-06074-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yolanda M López-Fernández
- Pediatric Intensive Care Unit, Department of Pediatrics, Biocruces Health Research Institute, Cruces University Hospital, Plaza Cruces 12, 48903, Barakaldo, Bizkaia, Basque Country, Spain.
| | - Lincoln S Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Joseph G Kohne
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan CS. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Jason P Weinman
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Alberto Medina
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Byron E Piñeres-Olave
- Department of Pediatric Critical Care Medicine, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Natalie Mahieu
- Department of Radiology, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA.,Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Margaret J Klein
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan CS. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Philippe Jouvet
- Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Los Angeles, University of Southern California, Los Angeles, CA, USA
| | | |
Collapse
|
3
|
Pons-Odena M, Medina A, Modesto-Alapont V. Treachery on the Rocks in the Pediatric Intensive Care Unit. JAMA Pediatr 2019; 173:699. [PMID: 31081855 DOI: 10.1001/jamapediatrics.2019.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martí Pons-Odena
- Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, Spain
| | - Alberto Medina
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | | |
Collapse
|
4
|
Medina A, Modesto-Alapont V, Lobete C, Vidal-Micó S, Álvarez-Caro F, Pons-Odena M, Mayordomo-Colunga J, Ibiza-Palacios E. Is pressure-regulated volume control mode appropriate for severely obstructed patients? J Crit Care 2014; 29:1041-5. [PMID: 25108834 DOI: 10.1016/j.jcrc.2014.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/05/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Management of mechanical ventilation in severely obstructed patients remains controversial. Pressure-regulated volume control ventilation (PRVCV) has been suggested to be the best option, as it should ensure a prefixed tidal volume at the lowest peak inspiratory pressure. We sought to determine the accuracy of the delivered volume, compared with the programmed volume, when using PRVCV. MATERIALS AND METHODS Experimental work performing ventilation simulations using volume control ventilation (VCV), PRVCV, and pressure control ventilation (PCV). Each mode was tested at tidal volumes (TVs) of 200 and 500 mL at both low and high airway resistance. Evita XL and Servo-i ventilators were used. RESULTS At 200 ml TV with high resistance, volume delivered with Evita XL was 165 mL (95% confidence interval, 158-169) in VCV, 117 mL (95% confidence interval, 117-120) in PCV, and 120 (95% confidence interval, 115-121) in PRVCV (P<.001). Volume delivered with Servo-i was 133 mL (95% confidence interval, 130-136) in VCV, 108 mL (95% confidence interval, 104-111) in PCV, and 104 (95% confidence interval, 101-108) in PRVCV (P<.001). CONCLUSIONS In high-resistance simulations, the delivered volume was lower when using PCV or PRVCV modes than VCV mode. Pressure control ventilation or PRVCV may fail to provide programmed TV, ultimately leading to hypoventilation of the patient.
Collapse
Affiliation(s)
- Alberto Medina
- Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
| | | | - Carlos Lobete
- Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Silvia Vidal-Micó
- Paediatric Intensive Care Unit, Hospital Universitario La Fe, Valencia, Spain
| | - Francisco Álvarez-Caro
- Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | - Martí Pons-Odena
- Paediatric Intensive Care Unit, Hospital San Juan de Dios, Barcelona, Spain
| | - Juan Mayordomo-Colunga
- Paediatric Intensive Care Unit, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain
| | | |
Collapse
|