Classifying multicenter approaches to invasive mechanical ventilation for infants with bronchopulmonary dysplasia using hierarchical clustering analysis.

Autor: Kielt MJ; Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA., Hatch LD 3rd; Mildred Stahlman Division of Neonatology, Department of Pediatrics, Monroe Carrell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA., Levin JC; Divisions of Pulmonary and Newborn Medicine, Boston Children's Hospital and Harvard University Medical School, Boston, Massachusetts, USA., Napolitano N; Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA., Abman SH; Section of Pulmonary and Sleep Medicine, Pediatric Heart Lung Center, Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado, USA., Baker CD; Section of Pulmonary and Sleep Medicine, Pediatric Heart Lung Center, Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado, USA., Eldredge LC; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington, USA., Collaco JM; Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., McGrath-Morrow SA; Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, USA., Rose RS; Division of Neonatology, Department of Pediatrics, Riley Children's Hospital and Indiana University School of Medicine, Indianapolis, Indiana, USA., Lai K; Division of Pediatric Pulmonary and Sleep Medicine, Primary Children's Hospital and the University of Utah School of Medicine, Salt Lake City, Utah, USA., Keszler M; Division of Neonatology, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Sindelar R; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden., Nelin LD; Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA., McKinney RL; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2023 Aug; Vol. 58 (8), pp. 2323-2332. Date of Electronic Publication: 2023 Jun 02.
DOI: 10.1002/ppul.26488
Abstrakt: Introduction: Evidence-based ventilation strategies for infants with severe bronchopulmonary dysplasia (BPD) remain unknown. Determining whether contemporary ventilation approaches cluster as specific BPD strategies may better characterize care and enhance the design of clinical trials. The objective of this study was to test the hypothesis that unsupervised, multifactorial clustering analysis of point prevalence ventilator setting data would classify a discrete number of physiology-based approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD.
Methods: We performed a secondary analysis of a multicenter point prevalence study of infants with severe BPD treated with invasive mechanical ventilation. We clustered the cohort by mean airway pressure (MAP), positive end expiratory pressure (PEEP), set respiratory rate, and inspiratory time (Ti) using Ward's hierarchical clustering analysis (HCA).
Results: Seventy-eight patients with severe BPD were included from 14 centers. HCA classified three discrete clusters as determined by an agglomerative coefficient of 0.97. Cluster stability was relatively strong as determined by Jaccard coefficient means of 0.79, 0.85, and 0.77 for clusters 1, 2, and 3, respectively. The median PEEP, MAP, rate, Ti, and PIP differed significantly between clusters for each comparison by Kruskall-Wallis testing (p < 0.0001).
Conclusions: In this study, unsupervised clustering analysis of ventilator setting data identified three discrete approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD. Prospective trials are needed to determine whether these approaches to mechanical ventilation are associated with specific severe BPD clinical phenotypes and differentially modify respiratory outcomes.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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