Identifying a pediatric cohort to prospectively evaluate ventilation strategies to mitigate postoperative pulmonary complications

• DOI: 10.1111/pan.14549
• Publication Date: 2022-08-26T06:58:22Z
• Authors: Eric C. Cheon; Heather A. Ballard; Nicholas E. Burjek; Mitchell Phillips; Alison Robles; Mehul V. Raval
• Keywords: Institutional review board

Lung-protective ventilation (LPV) may decrease postoperative pulmonary complications by minimizing driving pressure.1 Lee and colleagues recently found that tidal volumes of 5 ml/kg a PEEP 10 most effectively optimize for pressure in patients ≤6 years old.2 Despite this knowledge, adoption LPV into current pediatric clinical practice is lagging has not been validated with large-scale randomized controlled trials (RCT).3 In order to conduct prospective RCT evaluate LPV, the ideal study population needs be defined. Children old experience highest frequency complication,4 making them promising target population. Further delineation subgroups within cohort complication rates necessary ensure an adequately powered RCT. Utilizing American College Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P), we sought identify surgical procedures which age incidence pneumonia or reintubation. These national data were further augmented institutional including oxygen dependence. The NSQIP-P prospectively collected, multicenter registry, provides on risk-adjusted outcomes participating hospitals. Trained reviewers collect thoroughly standardized through in-depth chart reviews phone calls patient families. scope covers 147 different variables per patient, demographics, comorbidities, intraoperative factors, 30-day outcomes. Ann & Robert H. Lurie Children's Hospital Chicago Institutional Review Board deemed exempt from review waiver signed consent. All analyses performed using SAS version 9.3 (SAS Institute). Patients who underwent surgery at hospital January 1, 2014, December 31, 2020, examined (n = 523 233). emergent/urgent status preoperative mechanical excluded. 266 523) included analysis. occurrence unplanned reintubation 7 days was measured dataset.5 1593 (0.6%) had Univariable logistic regression then used specialties risk as compared Urology, lowest General [Odds Ratio 9.49 (95% confidence interval 7.35–12.25); p < .0001] strongest association outcome. Table 1 lists top ten general composite Data June 9, 2021, March 2022 50), collected authors' institution. undergoing equivalent severity selected following procedural exceptions: laparoscopic gastrostomy tube placement fundoplication (both commonly address aspiration) intrathoracic surgery, these felt potentially confound any effect LPV. ≥7 old, supplemental oxygen, active COVID-19 infection Occurrence dependence (reintubation, noninvasive positive ventilation, high-flow nasal cannula, mask, cannula) those patients. Of 50 patients, 13 (26%) required support. conclusion, specific particularly high complications. Those sizable abdominal insult comprised many similar what Foutier et al. identified adults.5 By targeting based only two variables, procedure type, research personnel able focus enrollment efforts optimally power designed assess impact strategies Based pilot two-sided significance level .05 80% power, 290 major would needed detect 50% reduction Enrollment thus feasible support findings are available request corresponding author. publicly due privacy ethical restrictions.