Ventilation Intensity and Prognosis in Pediatric Oncology: Mechanical Power, Compliance, and Mortality Risk.

BACKGROUND

Mechanical power (MP) and dynamic compliance (Cdyn) are key determinants of ventilator-induced lung injury (VILI) and mortality. This study aimed to identify variables associated with MP and Cdyn and evaluate their impact on mortality and ventilator-free days (VFD) in critically ill children with cancer.

METHODS

We conducted a prospective, observational study of 57 patients. Multivariate logistic regression and competing risk models were applied to assess predictors of mortality and VFD.

RESULTS

The median age was 69 months, with a median of three organ dysfunctions. Mechanical power normalized by dynamic compliance (MP/Cdyn) emerged as an independent predictor of mortality across multivariable models: MP/Cdyn was significantly associated with death alongside the number of organ dysfunctions (OR: 5.44, 95% CI: 1.78-18.6, p = 0.003; OR: 1.62, 95% CI: 1.07-2.47, p = 0.023), platelet count <30,000/μL (OR: 4.23, 95% CI: 1.36-13.1, p = 0.013; OR: 4.92, 95% CI: 1.31-18.4, p = 0.018), and renal and immunologic dysfunctions. ROC analysis of MP/Cdyn for ICU mortality yielded an AUC of 0.76, with a cutoff of 1.11 J·cmH2O/min·mL (sensitivity 59%, specificity 89%). Kaplan-Meier analysis showed significantly lower survival for MP/Cdyn >1.11 (p = 0.016). Higher MP was also associated with fewer 28-day VFD (SHR: 0.17, 95% CI: 0.04-0.8, p = 0.026). VFD also correlated with Cdyn/PBW, PCO2, B-lines on lung ultrasound, and oxygen saturation index.

CONCLUSIONS

In critically ill children with cancer, elevated mechanical power is strongly linked to reduced ICU survival and fewer VFD. These findings highlight the prognostic importance of ventilation strategies in this vulnerable population.