Respiratory care · 2026
Agreement Between Automated and Equation-Derived Mechanical Power in Pediatric Mechanical Ventilation.
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Shaikh Farhan A Rashid, Bhaskaran Monesh Kethineni, Muppa Vikas, Jogu Suchit, Charantimath Pallavi, Sachane Kapil B, Yerra Anupama, Chirla Dinesh Kumar, Venkatraman Shekhar, Kneyber Martin C J
Аннотация
BACKGROUND: Newer ventilators provide automated real-time mechanical power (MPauto) measurements, but their accuracy in children across ventilation modes remains uncertain. We aimed to evaluate the agreement between the MPauto measured on the Mindray SV-600 ventilator and the equation-derived MP (MPcalc) across two tidal volume (VT) settings, ventilation modes, and predefined age groups in ventilated children.
METHOD: In this prospective observational physiology study, consecutive mechanically ventilated children aged 1 month to 18 years were enrolled between August 2024 and May 2025 in a 30-bed pediatric ICU. MPauto was compared with MPcalc, using comprehensive and surrogate equations during continuous mandatory volume-control (VC-CMV) and pressure-control (PC-CMV) modes at VT of 6 and 8 mL/kg body weight. Subgroup analyses considered age and pediatric ARDS. In VC-CMV mode, MP was calculated with Gattinoni's equation (MPVCcomprehensive) and Giosa's equation (MPVCsurrogate). In PC-CMV mode, Van der Meijden's equation (MPPCcomprehensive) and Becher's equation (MPPCsurrogate) were used. Bland-Altman analyses evaluated agreement.
RESULTS: We included 147 children, with a median (interquartile range [IQR]) age of 49 (16-92) months, of whom 34 (23%) had pediatric ARDS. MPauto showed strong agreement with MPcalc across ventilation modes and VT settings. The agreement was highest in VC-CMV, with minimal bias (-0.12 to +0.011 J/min; intra-class correlation [ICC] ≥0.95) and >88% of observations within clinical limits of agreement. In PC-CMV, MPauto demonstrated a systematic negative bias relative to MPcalc (minimal bias -1.23 to -0.62 J/min; ICC ≥0.92), with similar findings in subjects with pediatric ARDS. Age influenced agreement between MPauto and MPcalc (slope -0.008 to -0.005), especially in PC-CMV mode (R2 = 0.226-0.27). Pediatric ARDS status affected this relationship only in PC-CMV mode (P = .02 for MPPCcomprehensive and P = .006 for MPPCsurrogate).
CONCLUSION: MPauto demonstrated strong agreement with equation-derived MP during VC-CMV mode across different age groups. However, MPauto showed a systematic negative bias relative to equation-derived MP in PC-CMV mode, particularly among younger children and those with pediatric ARDS.
METHOD: In this prospective observational physiology study, consecutive mechanically ventilated children aged 1 month to 18 years were enrolled between August 2024 and May 2025 in a 30-bed pediatric ICU. MPauto was compared with MPcalc, using comprehensive and surrogate equations during continuous mandatory volume-control (VC-CMV) and pressure-control (PC-CMV) modes at VT of 6 and 8 mL/kg body weight. Subgroup analyses considered age and pediatric ARDS. In VC-CMV mode, MP was calculated with Gattinoni's equation (MPVCcomprehensive) and Giosa's equation (MPVCsurrogate). In PC-CMV mode, Van der Meijden's equation (MPPCcomprehensive) and Becher's equation (MPPCsurrogate) were used. Bland-Altman analyses evaluated agreement.
RESULTS: We included 147 children, with a median (interquartile range [IQR]) age of 49 (16-92) months, of whom 34 (23%) had pediatric ARDS. MPauto showed strong agreement with MPcalc across ventilation modes and VT settings. The agreement was highest in VC-CMV, with minimal bias (-0.12 to +0.011 J/min; intra-class correlation [ICC] ≥0.95) and >88% of observations within clinical limits of agreement. In PC-CMV, MPauto demonstrated a systematic negative bias relative to MPcalc (minimal bias -1.23 to -0.62 J/min; ICC ≥0.92), with similar findings in subjects with pediatric ARDS. Age influenced agreement between MPauto and MPcalc (slope -0.008 to -0.005), especially in PC-CMV mode (R2 = 0.226-0.27). Pediatric ARDS status affected this relationship only in PC-CMV mode (P = .02 for MPPCcomprehensive and P = .006 for MPPCsurrogate).
CONCLUSION: MPauto demonstrated strong agreement with equation-derived MP during VC-CMV mode across different age groups. However, MPauto showed a systematic negative bias relative to equation-derived MP in PC-CMV mode, particularly among younger children and those with pediatric ARDS.