Can Mechanical Power be Used as a Safety Precaution in Pediatric Patients?

Abstract

Objective: Mechanical power (MP) is the amount of energy transferred to the respiratory system of patients during each breath period. After overcoming the resistances required for respiration, the remaining energy may end up by damaging the lung parenchyma. The MP limit that should not be exceeded in pediatric patientsis not yet clear. The aim of this observational descriptive study is to compare the perioperative MP measurements in healthy pediatric cases with the values given in the literature. Methods: Perioperative MP was calculated according to the simplified MP formula in pediatric patients without known lung disease and compared with the literature. Results: The mean age of 34 patients was 68.88±31.4 months and the mean weight was 21.82±7.5 kg. The mean MP was 3.93±1.1 J min -1 , and the indexed MP was 0.19±0.08 J min -1 kg -1 . Both MP (p=0.008) and indexed MP (p<0.001) were significantly higher in patients with high tidal volume. In addition, we found a negative correlation between indexed MP and weight (r: -668 and p<0.001). Both MP and indexed MP had sufficient predictive power to predict tidal volume >10 and predictive value was significant [Auc: 0.764, 95%CI: 0.55-0.97, p: 0.026]. The value of MP>3.76 was an indicator for tidal volume >10 with 87 sensitivity and 50 specificity. Predictive value of indexed MP for tidal volume >10 mL kg -1 was 0.25 J kg -1 [AUC 0.856, 95%CI: 0.70-1.0, p=0.003], and indexed MP was a stronger indicator than MP. Conclusion:This study revealed that MP threshold values calculated for adults or patients with ARDS lung are not sensitive for pediatric patients, and a new threshold value should be determined for these patients.