Table 4.
Clinical condition, ventilatory parameters, and recorded values at each measurement (PICU group)
| All | Measurement 1 | Measurement 2 | Measurement 3 | Measurement 4 | |
|---|---|---|---|---|---|
| Number of measurements | 59 | 19 | 18 | 14 | 8 |
| Duration of MV at measurement (hours), median (Q1–Q3) | 34.7 (22.9–49.6) | 20.7 (13.9–21.7) | 33.5 (30.4–38.4) | 49.6 (43.1–59.7) | 69.3 (58.4–80.8) |
| PELOD-2 score, median (Q1–Q3) | 8 (6–9) | 9 (7.5–11.5) | 7 (5.3–8.8) | 7 (5.3–8) | 8 (6.5–8.3) |
| Sedation used within 4 h before measurements, n (%) | |||||
| Opioids | 52 (88.1%) | 18 (94.7%) | 17 (94.4%) | 11 (78.6%) | 6 (75%) |
| Benzodiazepines | 17 (28.8%) | 5 (26.3%) | 5 (27.8%) | 5 (35.7%) | 2 (25%) |
| Propofol | 1 (1.7%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (12.5%) |
| Dexmedetomidine | 32 (54.2%) | 11 (57.9%) | 11 (61.1%) | 9 (64.3%) | 1 (12.5%) |
| Total opioid received before measurements, n (%), median morphine equivalent dose (mg/kg) (Q1–Q3) | |||||
| Within 4 h before measurements |
52 (88.1%) 0.28 (0.15–0.53) |
18 (94.7%) 0.45 (0.15–0.54) |
17 (94.4%) 0.4 (0.17–0.53) |
11 (78.6%) 0.23 (0.16–0.34) |
6 (75%) 0.24 (0.18–0.34) |
| Within 30 min before measurements |
38 (64.4%) 0.08 (0.04–0.14) |
13 (68.4%) 0.08 (0.05–0.14) |
13 (72.2%) 0.08 (0.05–0.14) |
7 (50%) 0.03 (0.02–0.07) |
5 (62.5%) 0.12 (0.08–0.19) |
| Sedation scores at measurements, median (Q1–Q3) | |||||
| RASS | − 1 (− 2 to 1) | − 1 (− 3 to 0.5) | − 1 (− 1.5 to − 1) | − 1 (− 1.5 to − 0.8) | 2 (2–2) |
| COMFORT-B | 12 (10–14) | 12 (9–13) | 12 (9.8–13) | 12 (11–13.8) | 14 (12–17.3) |
| Ventilation mode, n (%) | |||||
| Assist, volume-control | 6 (10.2%) | 3 (15.8%) | 3 (16.7%) | 0 (0%) | 0 (0%) |
| Assist, pressure-control | 13 (22%) | 5 (26.3%) | 4 (22.2%) | 3 (21.4%) | 1 (12.5%) |
| Assist, pressure-regulated volume control | 13 (22%) | 6 (31.6%) | 4 (22.2%) | 1 (7.1%) | 2 (25%) |
| Support, pressure-control (PSV) | 15 (25.4%) | 4 (21.1%) | 4 (22.2%) | 5 (35.7%) | 2 (25%) |
| Support, neurally adjusted (NAVA) | 12 (20.3%) | 1 (5.3%) | 3 (16.7%) | 5 (35.7%) | 3 (37.5%) |
| Ventilation parameters | |||||
| Tidal volume (ml/kg), median (Q1–Q3) | 6.5 (5.2–7.8) | 6.5 (5.4–7.4) | 6.9 (6.2–8.6) | 6.6 (5.2–8.1) | 5.7 (5–6.6) |
| Respiratory rate above set, for non-spontaneous modes (%), median (Q1–Q3) | 12.4% (3.3–28.9%) | 8.7% (1.4–27.9%) | 13.3% (7.3–25.7%) | 2.2% (0–33.3%) | 24% (19.1–93.3%) |
| NAVA level (cmH2O/µV), median (Q1–Q3) | 0.6 (0.5–1) | 0.5 | 0.5 (0.5–1) | 0.8 (0.5–1) | 0.6 (0.6–0.8) |
| Delta pressure (cmH2O), median (Q1–Q3) | 11 (6–14.5) | 12 (8.5–18) | 11 (8.5–14.8) | 7.5 (5.3–12) | 5.5 (3.8–12) |
| PEEP (cmH2O), median (Q1–Q3) | 6 (5–8) | 6 (5–8.5) | 7 (5–8) | 6.5 (5.3–7) | 6 (5.8–6.3) |
| FiO2 (%), median (Q1–Q3) | 35% (25–45%) | 40% (25–55%) | 32.5% (22–49%) | 30.5% (25–40%) | 35.5% (30–43%) |
| Ventilation effectiveness | |||||
| SpO2 (%), median (Q1–Q3) | 99% (96–100%) | 98% (96–100%) | 100% (99–100%) | 96.5% (96–99%) | 99% (97–100%) |
| pH, median (Q1–Q3) | 7.39 (7.35–7.42) | 7.4 (7.36–7.43) | 7.37 (7.34–7.43) | 7.39 (7.35–7.41) | 7.39 (7.37–7.42) |
| PCO2 (mmHg), median (Q1–Q3) | 43.9 (37.8–52.5) | 42.1 (35.7–50.1) | 43.1 (37.6–50.2) | 44.9 (40.9–54.9) | 47.3 (43.1–55.4) |
| Median baseline EAdimax 60 min before measurement (µV), median (Q1–Q3) | 5.7 (2.9–10) | 3.8 (2.9–7.2) | 6.5 (2.7–10.5) | 5.3 (2.9–11.9) | 9.3 (6.6–13.7) |
| Maximum ΔPawmax (cmH2O), median (Q1–Q3) | 28.7 (20.8–55.4) | 35.1 (21–58) | 26.7 (21.1–43.1) | 27.8 (20.9–41.1) | 47.2 (22.2–73.1) |
| Median NMEoccl (cmH2O/µV), median (Q1–Q3) | 1.6 (0.9–2.6) | 1.8 (1.3–2.4) | 1.9 (1.4–2.6) | 1.3 (0.9–2.7) | 0.9 (0.7–1.6) |
PICU denotes pediatric intensive care unit, Q1–Q3 first and third quartiles, MV mechanical ventilation, PELOD pediatric logistic organ dysfunction, RASS Richmond agitation–sedation scale, PSV pressure-support ventilation, NAVA neurally adjusted ventilatory assist, PEEP positive end-expiratory pressure, FiO2 fractional concentration of inspired oxygen, SpO2 oxygen saturation, PCO2 blood carbon dioxide pressure, EAdimax peak electrical activity of the diaphragm, ΔPawmax maximum inspiratory airway pressure deflection over 5 occluded breaths, NMEoccl median neuro-mechanical efficiency ratio (defined as inspiratory airway pressure divided by peak electrical activity of the diaphragm) over 5 occluded breaths