Pediatric ARDS Study Shows Early Weaning Benefit With Lung-Diaphragm Protective Ventilation
USA: A randomized controlled trial conducted by Dr. Robinder G. Khemani and his team at the Keck School of Medicine, University of Southern California, suggests that using a targeted lung and diaphragm protective ventilation strategy in children may lead to quicker weaning from mechanical ventilation. The study, recently published in NEJM Evidence, explored whether a computer-guided ventilation approach could improve clinical outcomes in pediatric patients with acute respiratory distress syndrome (ARDS).
The trial, conducted at a single center between October 2017 and March 2024, enrolled 248 children who required mechanical ventilation for ARDS. Participants were randomly allocated into intervention and control groups at two key stages: the acute phase and the weaning phase of ventilation. The intervention group was managed using a computerized decision support system named REDvent, which was used with esophageal manometry to fine-tune ventilator settings with the goal of protecting both lung and diaphragm function. The control group received standard care at the clinician's discretion.
The researchers note that a key feature of the study was the use of a standardized daily spontaneous breathing trial (SBT) in both groups, helping assess readiness for weaning off the ventilator. The primary outcome measured was the duration of the weaning phase.
The key findings were as follows:
- The REDvent-guided strategy resulted in more favorable ventilator settings during patient-triggered breathing.
- The intervention group had lower peak inspiratory pressure, with a reduction of 3 cmHâ‚‚O compared to the usual care group.
- Positive end-expiratory pressure (PEEP) was reduced by 2 cmHâ‚‚O in the REDvent group.
- Esophageal pressure swings were smaller in the REDvent group, indicating less respiratory effort.
- 55% of children in the REDvent-acute group passed their spontaneous breathing trial (SBT) or were extubated on the first trial day, compared to 39% in the usual care group.
- The odds of a shorter weaning period were significantly higher in the REDvent group (odds ratio: 1.67) after adjusting for clinical factors.
- The median time from intubation to successful SBT was 3.83 days in the REDvent group compared to 4.75 days in the usual care group.
- There were no significant differences in outcomes between groups during the weaning phase.
- There was no increase in adverse events in the REDvent group, indicating the intervention's safety.
The researchers conclude that implementing a lung and diaphragm protective approach, guided by decision-support tools during the early phase of mechanical ventilation, could meaningfully reduce weaning time in children with ARDS. These promising results support the need for larger, multi-center Phase III trials to further validate the effectiveness of this strategy in broader pediatric populations.
Reference:
DOI: 10.1056/EVIDoa2400360
