Lippincott Williams & Wilkins



Online Data SupplementTitle: Lung Protective Mechanical Ventilation Strategies in Pediatric Acute Respiratory Distress SyndromeAuthors: Judith Ju Ming Wong, MBBCh BAO, MRCPCH, Siew Wah Lee, MD, MRCPCH, Herng Lee Tan, MSc, Ma Yi-Jyun, BSc, Rehana Sultana, MSc (Stat), Yee Hui Mok, MBBS, MRCPCH, Jan Hau Lee MBBS, MRCPCH, MCISupplementary Table 1a: Lung protective mechanical ventilation protocolProtocol elementsTarget patientsTargets Peak/ plateau pressureAll CMV <28 cmH2OTidal volumeAll CMV 3-6ml/kgPositive end expiratory pressureAll CMV Incremental FiO2/PEEP combinations:FiO2.30.40.40.40.50.50.60PEEP56810101212FiO2.60.70.70.80.80.901.0PEEP14141616161616Permissive hypercapniaModerate & severe PARDSpH 7.2-7.30Permissive hypoxiaAt risk & mild PARDSSpO2 92-97%Moderate & severe PARDSSpO2 88-92%Supplementary Table 1b: Predicted body weight to tidal volume chart for boys (based on Singapore Health Promotion Board growth charts)Height (cm)PBW (kg)TV 3ml/kgTV 6ml/kgHeight (cm)PBW (kg)TV 3ml/kgTV 6ml/kg503.4102010015.04590554.5142811018.355115606.0183612022.970140657.3224413028.085170708.3245014034.9100210759.2285615042.61302608010.3306216051.01503108511.4346817059.81803609012.5387618068.02004109513.84084PBW – predicted body weightTV – tidal volumeSupplementary Table 1c: Predicted body weight to tidal volume chart for girls (based on Singapore Health Promotion Board growth charts)Height (cm)PBW (kg)TV 3ml/kgTV 6ml/kgHeight (cm)PBW (kg)TV 3ml/kgTV 6ml/kg503.3102010014.84590554.4132611018.055110605.75183412022.570135656.8204013026.880160708.0244814033.9100200758.9285415042.11252508010.0306016050.71503008511.0346617057.81703509012.1367218062.71903809513.34080PBW – predicted body weightTV – tidal volumeSupplementary Table 2: Ventilation day gridNon-protocol daysProtocol daysAt riskMildModerateSevereMissing Total At riskMildModerateSevereMissingTotalCMV63944514132297813850234293Non-CMV932635001541102837076NIV*992121Oxygen*1144Total 72126108642339379148786029394*Not included in analysis of ventilation elementsCMV – conventional mechanical ventilationNIV – non-invasive ventilationSupplementary Table 3: Sensitivity analysis using predicted body weight for calculation of tidal volumesVentilation elementTarget patientsNumber of days compliant to ventilation elements*P valueNon-protocol group (n=393)Protocol group (n=394)Tidal volume,3-6ml/kg PBWAll CMV 75/203 (36.9)111/288 (38.5)0.720Median tidal volume, ml/kg predicted body weightAll CMV At risk and mild PARDSModerate and severe PARDS6.1 (5.0, 7.7)6.1 (4.8, 7.6)6.2 (5.2, 7.6)6.1 (4.9, 7.3)6.2 (5.0, 7.4)5.7 (3.8, 7.0)0.2770.7580.080*Numbers may not add up exactly due to missing data (please see Supplementary Table 1: Ventilation day grid)PBW – predicted body weight, PARDS – pediatric acute respiratory distress syndrome, CMV – conventional mechanical ventilationSupplementary Figure 1a: Bland-Altman plot of differences between actual and predicted body weight and Figure 1b: Bland-Altman plot of differences between tidal volume per actual and predicted body weight TV – tidal volumeABW – actual body weightPBW – predicted body weight ................
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