The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points

Herng Lee Tan, MSc; Rehena Sultana, MSc(stat); Phuc Huu Phan, MD; Muralidharan Jayashree, MD; Hongxing Dang, MD; Soo Lin Chuah, MBBS; Chin Seng Gan, MBBS; Siew Wah Lee, MD; Karen Ka Yan Leung, MBBS, MSc; Ellis Kam Lun Hon, MBBS, MD; Xuemei Zhu, MD; Pei Chuen Lee, MMed(Paeds); Chian Wern Tai, MD; Jacqueline Soo May Ong, MB BChir; Lijia Fan, MD; Kah Min Pon, MD; Li Huang, MD; Kazunori Aoki, MD; Hiroshi Kurosawa, MD, PhD; Rujipat Samransamruajkit, MD; Jia Yueh Chong, MD; Felix Liauw, MD; Nattachai Anantasit, MD; Wei Xu, MD; Chunfeng Liu, MD; Jan Hau Lee, MBBS; Louise Ngu, MB BCh BAO; Yek Kee Chor, MD; Suparyatha Ida Bagus Gede, MD; Dyah Kanya Wati, MD; Judith Ju Ming Wong, MB BCh BAO

doi:10.1016/j.chstcc.2025.100162

CHEST Critical Care (Sep 2025)

The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points

Herng Lee Tan, MSc,
Rehena Sultana, MSc(stat),
Phuc Huu Phan, MD,
Muralidharan Jayashree, MD,
Hongxing Dang, MD,
Soo Lin Chuah, MBBS,
Chin Seng Gan, MBBS,
Siew Wah Lee, MD,
Karen Ka Yan Leung, MBBS, MSc,
Ellis Kam Lun Hon, MBBS, MD,
Xuemei Zhu, MD,
Pei Chuen Lee, MMed(Paeds),
Chian Wern Tai, MD,
Jacqueline Soo May Ong, MB BChir,
Lijia Fan, MD,
Kah Min Pon, MD,
Li Huang, MD,
Kazunori Aoki, MD,
Hiroshi Kurosawa, MD, PhD,
Rujipat Samransamruajkit, MD,
Jia Yueh Chong, MD,
Felix Liauw, MD,
Nattachai Anantasit, MD,
Wei Xu, MD,
Chunfeng Liu, MD,
Jan Hau Lee, MBBS,
Louise Ngu, MB BCh BAO,
Yek Kee Chor, MD,
Suparyatha Ida Bagus Gede, MD,
Dyah Kanya Wati, MD,
Judith Ju Ming Wong, MB BCh BAO

Affiliations

Herng Lee Tan, MSc: Respiratory Therapy Service, Division of Allied Health Specialties, KK Women’s and Children’s Hospital, Singapore; Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore
Rehena Sultana, MSc(stat): Center for Quantitative Medicine, Duke-NUS Medical School, Singapore
Phuc Huu Phan, MD: Vietnam National Children’s Hospital, Hanoi, Vietnam
Muralidharan Jayashree, MD: Postgraduate Institute of Medical Education and Research, Chandigarh, India
Hongxing Dang, MD: Children’s Hospital of Chongqing Medical University, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
Soo Lin Chuah, MBBS: University Malaya Medical Centre, Kuala Lumpur, Malaysia
Chin Seng Gan, MBBS: University Malaya Medical Centre, Kuala Lumpur, Malaysia
Siew Wah Lee, MD: Sultanah Aminah Hospital, Johor, Malaysia; Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
Karen Ka Yan Leung, MBBS, MSc: Paediatric Intensive Care Unit, Hong Kong Children’s Hospital, Special Administrative Region in China, China
Ellis Kam Lun Hon, MBBS, MD: Paediatric Intensive Care Unit, Hong Kong Children’s Hospital, Special Administrative Region in China, China
Xuemei Zhu, MD: Children’s Hospital of Fudan University, Shanghai, China
Pei Chuen Lee, MMed(Paeds): Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Chian Wern Tai, MD: Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Jacqueline Soo May Ong, MB BChir: Division of Paediatric Critical Care, National University Hospital, Singapore
Lijia Fan, MD: Division of Paediatric Critical Care, National University Hospital, Singapore
Kah Min Pon, MD: Penang General Hospital, Penang, Malaysia
Li Huang, MD: Department of Emergency, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
Kazunori Aoki, MD: Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan
Hiroshi Kurosawa, MD, PhD: Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan
Rujipat Samransamruajkit, MD: Division of Pediatric Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Jia Yueh Chong, MD: Hospital Tunku Azizah Kuala Lumpur, Kuala Lumpur, Malaysia
Felix Liauw, MD: Harapan Kita National Women and Children Health Center, Jakarta, Indonesia
Nattachai Anantasit, MD: Ramathibodi Hospital, Bangkok, Thailand
Wei Xu, MD: Shengjing Hospital of China Medical University, Liaoning, China
Chunfeng Liu, MD: Shengjing Hospital of China Medical University, Liaoning, China
Jan Hau Lee, MBBS: Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore; Duke-NUS Medical School, Singapore
Louise Ngu, MB BCh BAO: Sarawak General Hospital, Sarawak, Malaysia
Yek Kee Chor, MD: Sarawak General Hospital, Sarawak, Malaysia
Suparyatha Ida Bagus Gede, MD: Pediatric Emergency and Intensive Care Unit, Prof I.G.N.G Ngoerah Hospital, Bali, Indonesia; Medical Faculty, Udayana University, Bali, Indonesia
Dyah Kanya Wati, MD: Pediatric Emergency and Intensive Care Unit, Prof I.G.N.G Ngoerah Hospital, Bali, Indonesia; Medical Faculty, Udayana University, Bali, Indonesia
Judith Ju Ming Wong, MB BCh BAO: Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore; Duke-NUS Medical School, Singapore; CORRESPONDENCE TO: Judith Ju Ming Wong, MBBCh BAO

DOI: https://doi.org/10.1016/j.chstcc.2025.100162
Journal volume & issue: Vol. 3, no. 3
p. 100162

Abstract

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Background: The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect. Research Question: What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes? Study Design and Methods: This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder. Results: A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; P < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; P = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [P < .001]; direct effect, –1.17 [P = .635]; total effect, –5.47 [P = .024]) and IFDs [indirect effect, –3.13 [P < .001]; direct effect, –0.72 [P = .635]; total effect, –3.84 [P = .024]), but not ICU mortality. Interpretation: In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation.

Published in CHEST Critical Care

ISSN: 2949-7884 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/chest-critical-care

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